The Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW · 7/26/2016 · 07/16/6 101.05 Chief Officer’s update I Paul Kingan Governance ... • 2015/16 forecast outturn expenditure

NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP

GOVERNING BODY MEETING

26 July 2016, 9.30 – 11.30 am

The Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW

Item WLCCGB

Time Agenda item Action Presenter

07/16/1 9.30 Welcome Chair

07/16/2 1 9.35 Declaration of Interests All

07/16/3 9.40 Minutes of previous meeting held on 24 May 2016 DR Chair

07/16/4 1 9.45 Matters arising - Action sheet DR Chair

Communication

07/16/5 1 9.55 Chair’s update I Chair

07/16/6 1 10.05 Chief Officer’s update I Paul Kingan

Governance

07/16/7 10.15 BAF and risk register I Paul Kingan

Operational Management Section

07/16/8 1 10.30 Integrated business report D Paul Kingan

07/16/9 10.45 2016-17 Budget paper D Paul Kingan

07/16/10 10.55 Annual public health report I Sakthi Karunanithi

07/16/11 11.05 Declarations of Interests I Paul Kingan

07/16/12 11.10 Healthier Lancashire joint committee terms of reference DR Paul Kingan

Consent items

07/16/13 1 11.25 Minutes of sub-committees: - Quality and Safety Committee – June 2016 - Audit Committee – May 2016 - Executive Committee – 24 May – 5 July 2016

Other minutes: - System Resilience Group – May and June 2016 - Lancashire Health and Wellbeing Board – April 2016

I

Chair

Other Business

07/16/14 11.30 Any other business I Chair

Date and Time of Next Meeting – 27 September 2016, 9.30 – 11.30 am, Boardroom, Hilldale

15 minutes to be allocated for questions from members of the public based on agenda items. I – Information D-Discussion DR – Decision Required

Members of the governing body will be available after the close of the meeting for

informal discussion, time permitting

West Lancashire CCG 2016/17 Budgets – Update Paper

1. Introduction

West Lancashire CCG’s 2016-17 Financial Plan was presented to the Governing Body on the 22nd March. This was based on the CCG’s 2016-17 Activity and Finance Plan as submitted to NHS England. This paper updates the Governing Body on developments and how they have been translated into operational budgets for 2016/17.

2. Methodology

The planned expenditure figures in the Financial Plan were based on knowledge and assumptions as they stood at the time on the following parameters:

• 2015/16 forecast outturn expenditure • Efficiencies generated by the application of the tariff deflator on Provider contracts • Growth in activity volumes • Cost Pressures • QIPP savings • Planned investments (both recurrent and non-recurrent)

In the intervening period between the 22nd March and the Month 3 reporting period the CCG has refined the figures contained in the Financial Plan. The proposed budgets now reflect:

• Actual signed contract values • The finalised Prescribing budget • An enhanced understanding of the CCG’s expenditure commitments following the

conclusion of the 2015/16 financial year.

3. Revised 2016/17 Budgets

The table overleaf details the updated budgets and the changes when compared to the Financial Plan, followed by explanatory notes on selected movements. These budgets have been uploaded into the CCG’s financial reporting system (ISFE).

2016/17 Financial Plan Revisions

2016/17 Budget (at Month 3)

Note £000 £000 £000

Revenue Resource Limit a 150,641 334 150,975

Expenditure

Acute servicesAcute contracts -NHS (includes Ambulance services) b 74,418 1,750 76,167Acute contracts - Other providers (non-nhs, incl. VS) 5,103 (454) 4,648Acute - Other 550 121 671Acute - Exclusions/Cost per Case 254 30 284Acute - NCAs 1,271 (5) 1,266

Sub-total Acute services 81,595 1,441 83,036

Mental Health services MH contracts - NHS c 10,739 306 11,045MH contracts - Other providers (non-nhs, incl. VS) 107 (1) 106MH - Other 105 (27) 78MH - Exclusions/Cost per Case 1,593 (25) 1,568

Sub-total MH services 12,544 253 12,797

Community Health ServicesCH Contracts - NHS d 9,911 1,121 11,032CH contracts - Other providers (non-nhs, incl. VS) 792 34 826CH - Other 748 536 1,284CH - Exclusions/Cost per Case 611 24 635

Sub-total Community services 12,062 1,714 13,776

Continuing Care Services e 7,260 1,049 8,309Local Authority / Joint Services 1,038 (16) 1,022Free Nursing Care 975 (56) 919

Sub-total Continuing Care services 9,273 978 10,251

Primary Care servicesPrescribing 19,126 216 19,342Community Based Services 882 22 904Out of Hours/Urgent Care f 2,949 (1,712) 1,237

Sub-total Primary Care services 22,957 (1,473) 21,484

Other Programme servicesGP IT Costs 519 66 585NHS Property Services 1,017 (158) 859Voluntary Sector Grants/Services 14 (0) 14Social Care 2,442 - 2,442Other CCG reserves g 1,161 (2,382) (1,221)Other Programme Services 958 (113) 8451% Non Recurrent Reserve 1,468 3 1,471

Sub-total Other Programme services 7,579 (2,583) 4,996

Total - Commissioning services 146,010 330 146,340

Running Costs 2,370 - 2,370

Contingency 754 1 755

Total Application of Funds 149,134 331 149,465

Surplus/(Deficit) 1,507 3 1,510

Notes

a. Revenue Resource Limit – The overall resources available to the CCG have increased by £334k since the Financial Plan was issued. The CCG’s opening allocation was adjusted to take into account transfers of services previously deemed to be specialist. Additionally the CCG has received an allocation of £60k relating to Eating Disorders.

b. Acute Contracts (NHS Providers) – The figures in the financial plan have been superseded by actual contract values. The increase this figure is predominantly due to 2 factors:

• Activity relating to the walk in centre on the Ormskirk Hospital site (annual value

approximately £1.7m) was previously classed under ‘Urgent Care’ when charged by the West Lancashire Health Partnership. Now the Partnership has been disbanded it has been incorporated into the Southport and Ormskirk Hospitals NHS Trust contract and is classed within Acute Services.

• An element of planned QIPP savings that had been assigned to Acute Services within the initial financial plan have not yet been transferred out of Reserves. These budgets will be transferred out of Reserves when the CCG has greater certainty of the impact of the schemes on specific provider contracts.

Partially offsetting the above is a reassessment of the element of the Southport and Ormskirk NHS Trust contract relating to Community Services.

c. Mental Health Contracts (NHS) – The CCG has incorporated several discrete investments into the 2016/17 budget.

d. Community Health Contracts (NHS) – This increase is the opposite effect of the reassessment of

the element of the Southport and Ormskirk NHS Trust contract relating to Community Services mentioned in note b.

e. Continuing Care Services – 2015/16 outturn expenditure was higher than the levels included within the initial financial plan and accordingly the revised budget is set at a higher level.

f. Out of Hours/Urgent Care - This decrease is the opposite effect of the reclassification of the

Ormskirk walk in centre activity mentioned in note b.

g. Other Reserves – Included within this figure are negative budgets (and associated planned savings) relating to QIPP schemes that have not yet been applied to individual operational budget lines. Examples of such schemes are Outpatient attendance reductions and the redesign of MSK pathways. These budgets will be transferred out of Reserves when the CCG has greater certainty of the impact of the schemes on specific provider contracts.

4. Conclusion

The Governing Body are requested to approve the revised budgets as detailed in this paper.

Paul Jones Head of Finance 15 July 2015

West Lancashire Clinical Commissioning Group Governing Body meeting – 24 May 2016 Page 1 of 7

Minutes D R A F T

Meeting Title: West Lancashire Clinical Commissioning Governing Body Meeting

Date: 24 May 2016

Time: 10.00 – 12.00 noon Venue: The Artz Centre, Hartland, Birch Green, Skelmersdale, WN8 6QE

Present: Greg Mitten, Vice-Chair / Lay Member Mike Maguire, Chief Officer Paul Kingan, Chief Finance Officer/Deputy Chief Officer Douglas Soper, Lay Member Dr Adam Robinson, Secondary Care Consultant Dr John (Jack) Kinsey, GP Executive Lead Dr Vikul Mittal, GP Executive Lead Dr Peter Gregory, GP Executive Lead Dr Rakesh Jaidka, GP Executive Lead

In attendance: Cathy Ashcroft, Executive Assistant Ian Crabtree, Head of Services Policy Information and Commissioning, Lancashire County Council

Apologies: Dr John Caine, Chair Claire Heneghan, Chief Nurse Dr Bapi Biswas, GP Executive Lead Mike Kirby, Director of Corporate Commissioning, Lancashire County Council (in attendance) Lucinda McArthur, Senior Operating Officer (in attendance) Jackie Moran, Head of Quality, Performance and Contracting (in attendance) Sakthi Karunanithi, Director of Public Health and Wellbeing, Lancashire County Council (in attendance) Sheralee Turner-Birchall, Chief Officer, Healthwatch Lancashire (in attendance)

Agenda

Item WLCCGB/

Summary of Discussion Action

05/16/01 Welcome and apologies for absence The meeting of the West Lancashire Clinical Commissioning Group Governing Body was opened by Greg Mitten, Vice-Chair, in the absence of Dr John Caine. Dr Rakesh Jaidka and Dr Vikul Mittal were welcomed to their first meeting of the governing body as newly elected GP executive leads. Introductions were made to the members of the public present. No questions had been received from the public in respect of the agenda.

05/16/02 Declarations of interests No declarations were made which were pertinent to the agenda.

05/16/03 Minutes of previous meeting held on 22 March 2016 The minutes of the meeting held on 22 March were agreed as an accurate and correct record with an additional statement from Dr Peter Gregory: 03/16/6 Chief officer’s update. Community health services procurement - There was some disquiet from the membership council regarding OWLs not being shortlisted via the procurement process. A further amendment will be made to the following line: 03/16/9 Integrated Business Report – ‘The four-hour waiting target at A&E


has increased…’ will read ‘At A&E the four-hour wait time has increased and performance decreased…’. The governing body: approved the previous minutes.

05/16/04 Matters arising The action sheet was updated and additional item was raised: 03/16/07 Board Assurance Framework and Risk Register – The CQC report in respect of the inspection of Southport and Ormskirk Hospital NHS Trust has not been produced and the timeframe for the report is not yet known. When received, the report will be circulated. Informal feedback focuses on two areas: the fragile management team and A&E performance. Another change in the interim management team has taken place. Ann Marr (interim chief executive) has left the Trust and Kim Hodgson commenced for a few weeks. After which time it is understood that another medium-term interim chief executive will commence. Concern was raised over the turnover of interim staff in senior positions. Lisa Hunt, interim chief operating officer, is leaving and will be replaced by another interim chief operating officer until the post is recruited to permanently.

05/16/05 • Annual report • Annual governance statement (contained in the annual report) • Financial statements • External Audit findings report for the annual accounts • Management representation letter Paul Kingan confirmed that the audit committee had met that morning and agreed to recommend the approval of the audited annual accounts, and the submission of the management representation letter by the governing body. The design version of the annual report was available for the group to view. The audit findings report had provided an unqualified opinion on the financial statements. The governing body was asked to approve the annual accounts, annual report (containing the annual governance statement) and the management representation letter. The management representation letter is a standard letter and essentially gives confirmation that the CCG governing body members have fulfilled their responsibilities around preparation of the accounts. On approval, the letter will be signed by the chief officer and the vice-chair of the CCG, in the absence of the chair, on behalf of the governing body. The governing body thanked the team and all involved for producing the annual accounts and report including Paul Jones, Sara Daulby, Meg Pugh and Janet Kearton. The annual report provides a record of work achieved during the year and the community were thanked for their engagement. The governing body: approved the audited annual accounts, annual report and the management representation letter. It was agreed that Mike Maguire, chief officer and Greg Mitten, vice-chair (in the absence of the chair), will sign the management representation letter on behalf of the governing body.

COMMUNICATION 05/16/06 Chair’s update

The report provided members with an update on both strategic and operational issues since the last meeting. Greg Mitten highlighted key areas of interest:


• Rally Round – this is an online platform which allows the creation of a support network for an individual. The network communicates to manage day to day tasks. Rally Round has now been launched in the community and through partnership between the CCG, the CVS and others, Rally Round will provide knowledge, training and support to those who are digitally excluded.

• GP elections – Following the GP elections in March, special thanks was

given to Dr Simon Frampton and Dr Ros Bonsor, who have stepped down as GP clinical leads. Dr Rakesh Jaidka and Dr Vikul Mittal were welcomed as the new GP clinical leads.

• Assurance – the CCG received an overall indicative rating of ‘good’ at the

quarter 4 assurance meeting with NHS England. Moderation at regional level must take place before the final rating is confirmed. The area which did not achieve a ‘good’ rating was for the A&E performance at Southport and Ormskirk Hospital NHS Trust.

• West Lancs CVS Health Network – the CCG presented on digital health,

children’s mental health and the community health services procurement at the Health Network in April. The event was well attended and feedback was positive. The next event will take place on 6 July at Edgehill University and will focus on getting active eg around health, culture etc. The procurement slides are available on the CCG website.

The governing body: Noted the content of the report

05/16/07 Chief Officer’s update The report provided members with an update on both strategic and operational issues since the last meeting. Mike Maguire highlighted key areas of interest: • Planning Round 2016-17 – Quality Premium – the CCG submitted its

Quality Premium local measures 2016-17 to NHS England which are as follows: circulation, genito-urinary, cross-cutting. An assessment of 2015-16 performance measures will be required in September 2016. If achieved, funding is made available to the CCG.

• Better Care Fund – this fund is essentially a pooled budget being used to

decrease the number of unnecessary admittances to A&E. West Lancashire CCG was allocated a minimum contribution of £7,145,000. This will be used towards ‘Building the Future Together’ and across six shared schemes that support social care. The four prescribed national metrics remain the same: non elective admissions; delayed transfers of care, permanent admissions to residential and nursing care; and effectiveness of re-ablement.

Ian Crabtree confirmed that the disabled facilities grant has doubled this year to £10 million. The fund is used to make changes for the community via the district council. The allocation for West Lancashire will be identified and shared. Ian Crabtree will also establish if the funding has increased to address a backlog of work. Twenty occupational therapists will be funded to meet the increased demand. The CVS Health Network event on 6 July will involve the community support organisations.

• Communication and engagement – focus is currently on the community

procurement, musculoskeletal redesign, Rally Round and Well Skelmersdale. The patient experience group continues to operate and a new signposting document will be launched to assist in supporting

Ian Crabtree


patients / carers with complaints. • Community health services procurement – the process is progressing

with the CCG continuing to develop the contract documentation, governance framework and payment mechanism including developing the metrics. The Lancashire Health Overview and Scrutiny Committee stated their satisfaction with the CCG’s level of engagement.

The governing body: Noted the content of the report GOVERNANCE 05/16/08 Board Assurance Framework and Risk Register

The Board Assurance Framework (BAF) is a key part of the CCG’s governance arrangements. The CCG risk register has been reviewed to reflect the up to date position. The BAF now includes all risks scoring 12 and over. There are nine risks which are placed on the BAF and Paul Kingan highlighted the highest scoring risks as follows: Risk 44 – the ICO provider failing to meet the required level of delivery and performance due to a number of issues. Risk 8 – the lack of engagement of the provider in the quality agenda. Additional meetings have taken place over last couple of months but the risk remains red. Risk 40 - Cardiology services at the Trust, where there is a backlog of appointments and the unfilled consultant position is being re-advertised. Risk 35 - The risk around high cost packages of care was raised. With increased costs, sustainability is a concern. Patients are being reviewed on time and no Deprivation of Liberty (DoL) has been identified. This also covers learning disability patients and will relate to the takeover of Calderstones Partnership NHS Foundation Trust by Merseycare NHS Trust. Greg Mitten commented that from the BAF and the auditors opinion around quality received in the audit committee, it is positive to receive confirmation that the right procedures and measures are in place to monitor quality and include stakeholders. Risk 43 - Public health funding costs. There are no updates from the Lancashire Health and Wellbeing Board. This will be pursued and a report will be provided by Sakthi Karunanithi once completed. Risk 32 – the risk in outstanding reviews for continuing health care cases was highlighted. Claire Heneghan is leading on this issue and following additional resources being secured, the reviews process is near completion. There is confidence that this will result in a reduced level of risk. Risk 47 – Risk of DoL with backlog of court of protection. Ian Crabtree explained that on discharge from Calderstones Hospital, there are restrictions to be put in place and an application to the court of protection is required. Previously the Lancashire County Council had not agreed to fund some patients on discharge. An interim agreement had been reached with healthcare funding the patients and social care felt it inappropriate for social workers to submit the application to the court of protection. It is now agreed that where best placed, the application to court of protection will be submitted


by social care. The risk score should be reduced to reflect the lower risk. In response to a question as to whether there was a funding stream for the cases, Paul Kingan confirmed this was not the case and the CCG funded the majority of cases, with some cases falling under national specialised funding. The CCG fund approximately 250 patients with high cost packages ranging from £20,000 to £500,000 each per year. This is an issue in terms of sustainability which the CCG will need to revisit. It was confirmed that an interim manager is now in post to focus on learning disability patients. Calderstones Partnership NHS Foundation Trust is currently subject to acquisition by Merseycare NHS Trust. The governing body: noted the report

OPERATIONAL MANAGEMENT SECTION 05/16/09 Integrated Business Report (IBR)

The report provided summary information on the financial position and activity performance of the CCG to March and the financial positon for April 2016. It also included quality and performance analysis for community based targets for Southport and Ormskirk Hospital NHS Trust. Paul Kingan highlighted some key areas within the report: • At year end the CCG has delivered a surplus of £1.464 million marginally

exceeding the 1% target required by NHS England. • The report reflects financial performance, activity and quality indicators. • The CCG has been consistent over the last 6 months in terms of targets

met. Although the CCG is not currently in a strong recurrent financial position, the target was met.

• The main issue is planned care, of which the cost pressure is partly driven by lower than average waiting times.

• Unplanned care is currently stable although the CCG cannot be complacent.

• Prescribing budget –The figures increased in March and this additional pressure will be met from the new financial year’s budget.

The highlights of the performance section of the report were presented: • Ambulance turnaround times and attendance have been poor all year.

This is a system problem as delays are also caused by blockages at the A&E department.

• Infection – C. Difficile and MRSA infections missed their targets. • QIPP performance achieved just less than 80%. The saving schemes

need ongoing monitoring and the QIPP needs to be flexible and dynamic as the savings will be more difficult to achieve next year.

• All payment targets were achieved this year along with planned care waiting times targets.

The IBR report will be refreshed and Paul Kingan would be pleased to receive any comments or suggested changes. Mike Maguire confirmed that the coming year would be more difficult financially and there is a need to focus on higher costs services where the CCG spends significantly more than expected for the population, such as musculoskeletal. A question about the figures of over-performance on outpatient procedures was raised. This relates to a dispute with the Trust around inappropriate coding to the value of £0.5 million and the figure has been amended to reflect

All


the correct value. The external auditors are satisfied with this approach. The CCG has written to the Trust and will advise the governing body of the response. Southport and Formby CCG have taken the same action. Discussion continued around the financial pressures in the next financial year. Money is already allocated to budgets, 0.5% is set aside for contingencies and 1% ring-fenced as required by NHS England. In response to a question of what happens if the CCG goes over budget, Paul Kingan said that firstly the contingency reserve would be utilised, followed by discussion with NHS England of whether the 1% ring-fence could be utilised. After this any further overspend would then be at risk of not achieving the CCGs mandated surplus target. Further financial deterioration would mean greater scrutiny and pressure on the organisation to take evasive action during the year including some difficult decisions for the governing body. Doug Soper suggested looking at the QIPP for repeat prescribing, in which membership had also expressed an interest. An estimated saving from the main procurement has not been factored into next year. There was discussion around e-referral performance as part of the quality premium. Paul Kingan will report back to the governing body. The format of the serious untoward incidents item had changed and no longer provided detail of the cases or responses from the Trusts. There are currently 64 StEIS incidents open. Greg Mitten confirmed the quality and safety committee are aware of the cases and ensure that the level of challenge continues to be placed to achieve a resolution from the Trust. Claire Heneghan is leading at a senior level and Allison Sathiyanathan is looking at the processes for each event and ensuring that lessons are learned and items are closed. This can be included in the new version of the IBR. The quality and safety committee escalate quality issues to the collaborative commissioning forum. The minutes of the forum are then received by the quality and safety committee to allow monitoring of progress of the quality issues. The quality and safety committee will be asked to comment on the new format of the IBR. The committee now has representation for infection control from Jane Mastin from Lancashire County Council. The governing body: Noted the performance to date and the actions in place to improve performance.

Paul Kingan

Greg Mitten

05/16/10 Local Anti-Fraud Bribery and Corruption policy The CCG now have a Local Anti-Fraud Bribery and Corruption policy produced by the local counter fraud specialist, Ann Gregory. The policy explains the role of the chair, chief officer, chief finance officer etc and had been discussed in detail at the audit committee. The governing body: Approved the policy

05/16/11 Strategic Plan 2016-17 The strategic plan which lays out the strategic objectives for the year ahead, had been presented at the executive committee. Five overarching priorities have been identified: • Transform planned care – the CCG needs to improve and spend

significantly less on orthopaedics • Transform urgent and emergency care – work is needed on paediatric

urgent care


• Transform community services – need primary care working together • Transform outcomes in the most challenging long-tem conditions –

cancer, heart disease, diabetes • Transform outcome for those experiencing the most challenging heath

inequalities - relevant to Well Skelmersdale Work is taking place with staff and the GP leads to set objectives and monitor the plan through the executive committee and the Aspire performance management system. In terms of paediatric urgent care, there are higher levels of admissions than expected, but this will be due in part to the present of a paediatric A&E department. There is a need to use the out of hours service better for paediatrics. The ten national clinical standards which demonstrate good practice for all urgent care services were raised. The governing body: approved the strategic plan

CONSENT ITEMS 05/16/12 Minutes of sub-committees:

The minutes from the following meetings were noted by the Governing Body: - Quality and Safety Committee – April 2016 - Audit Committee – April 2016 - Executive Committee – 8 March – 3 May 2016

Other minutes: - Lancashire CCG Network – February and March 2016 - System Resilience Group – January, March and April 2016 - Lancashire Health and Wellbeing Board – February 2016 - West Lancashire Community Safety Partnership – May 2016 Doug Soper queried entries in the quality and safety committee minutes about job descriptions and mandatory training. There are current technical issues with the training system which is being addressed and job descriptions will be changed to reflect specific job roles. A comment was raised that there had been no representation from the Trust at one of the system resilience groups. A consistent management team is needed. The health and wellbeing board consists of the leader of county councils as chair, all CCGs, most district councils and a range of small organisations. It is the accountable body for all CCGs and oversees how we work together in the community. Creating one health and wellbeing board for the whole of Lancashire is being considered. The governing body: Noted the papers.

Other business 05/16/13 Any other business

None raised.

Meeting closed at 11.45 am

Date and time to next meeting: 26 July 2016, 9.30 – 11.30 am, Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW

Page 1 of 2

Agenda item no: WLCCGB 07/16/4

West Lancashire CCG Governing Body meeting Action sheet

Action Lead Date required by Action completed 01/16/10 Integrated Business Report (IBR) Ambulance turnaround time - A letter will be sent to NWAS to highlight the delays in ambulance turnaround times with regards to a specific incident. Also, to ask if the number of calls for ambulances to A&E has increased since 111 commenced. The 111 response form was felt to be inadequate. Charlotte McAllister will email GPs to inform them their feedback on 111 can be sent to [email protected] and copy the CCG for records.

Paul Kingan

Charlotte McAllister

26 July 2016

26 July 2016

Paul Kingan had spoken with Blackpool CCG and shared the details. Another case was raised during the meeting, which when shared with NWAS had resulted in a change in process to

prevent a re-occurrence.

05/16/07 Chief Officer’s update – Better care fund Ian Crabtree confirmed that the disabled facilities grant has doubled this year to £10 million. The fund is used to make changes for the community via the district council. The allocation for West Lancashire will be identified and shared. Ian Crabtree will also establish if the funding has increased to address a backlog of work.

Ian Crabtree

26 July 2016

(action completed on 4.7.16)

The 2015/16 figure for West Lancs was £543,000 last year and will be £989,185 this year as per the growth in the allocations. In respect of the 2015/16 figures were £510,291 was spent on 95 jobs. Nobody is queuing for jobs as we understand it. I have asked further questions about how this compares with other districts and this is being looked into.

05/16/09 Integrated Business Report (IBR) The IBR report will be refreshed and Paul Kingan would be pleased to receive any comments or suggested changes.

All

26 July 2016

mailto:[email protected]

Page 2 of 2

There was discussion around e-referral performance as part of the quality premium. Paul Kingan will report back to the governing body. The quality and safety committee will be asked to comment on the new format of the IBR.

Paul Kingan

26 July 2016

Greg Mitten

26 July 2016

Chair’s Update West Lancashire Clinical Commissioning Group Governing Body Meeting – 26 July 2016

1

Agenda number: WLCCGGB 07/16/5

WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT

DATE OF BOARD MEETING: 26 July 2016

TITLE OF REPORT: Chair’s Update

BRIEFING POINTS:

Does this report / its recommendations have implications and impact with regard to the following:

A. Commissioning Board’s Aims and Objectives

1. Quality (including patient safety, clinical effectiveness and patient experience) – please outline impact

No

2. Commissioning of hospital and community services – please outline impact

No

3. Commissioning and performance management of GP Prescribing – please outline impact

Yes

4. Delivering Financial Balance – please outline impact No

5. Development of the commissioning group as a commissioning organisation – please outline impact

Yes

B. Governance –

1. Does this report:

provide the Commissioning Board with assurance against any of therisks identified in the assurance framework (identify risk number)

have any legal implications

promote effective governance practice

Yes

2. Additional resource implications (either financial or staffing resources)

No

3. Health Inequalities No

4. Human Rights, Equality and Diversity Requirements No

5. Clinical Engagement Yes

6. Patient and Public Engagement No

REPORT PREPARED BY: Meg Pugh, head of communication and engagement

REPORT PRESENTED BY: Greg Mitten, lay member


2

WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHAIR’S UPDATE

PURPOSE

This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting.

ISSUES ARISING

URGENT CARE

1. The Ambulatory Emergency Care unit moved to a new home at Southport & OrmskirkHospital NHS Trust in June. The move has meant there are more bays on the unit, andthere is also a new phone line for GPs to discuss urgent issues directly with a clinician atthe trust. The phone number has been shared with West Lancashire GPs. The unitmeans that patients who need same day care can be seen and treated in a timely mannerand without the need for an admission.

2. The health service across Cheshire and Mersey has come together to tackle increasedelays in ambulance turnaround times across the region this winter. NHS England,hospital trusts and commissioners have developed an Ambulance Turnaround concordatwith aims and actions to reduce ambulance delays which impact patient care.

MACMILLAN PROGRAMME

3. GP, Dr Simon Frampton, has been appointed to lead the local Macmillan programme thatsupports West Lancashire patients, families and carers in living with and beyond cancer.He takes over from Dr Jack Kinsey.

4. The Macmillan Cancer Information and Support Service, which is a joint initiative by NHSWest Lancashire Clinical Commissioning Group (CCG), Southport & Ormskirk HospitalNHS Trust and Macmillan Cancer Support, aims to ensure that those living with andbeyond cancer get the care and support they need to lead as healthy and active a life aspossible, for as long as possible.

5. The new project will encompass emotional social and physical needs alongside thedelivery of clinical care.

6. As part of the new project, a Macmillan Cancer Information and Support Centre will beopening in a community venue in 2016 and will provide practical and financial advice andemotional support to patients, families and carers on a drop in basis.

7. Pop up Macmillan information stands will be available at other locations across WestLancashire.

8. The physical activity programme Move More continues to run.


3

MEDICINES WASTE CAMPAIGN

9. The CCG would like to significantly improve its processes around the ordering and issuingof prescriptions to help minimise the high levels of medicines waste it is experiencing.

10. There is agreement from the GP membership to address this waste issue urgently.

11. Best practice suggests that patients/carers are responsible for checking their repeatmedicine needs and are encouraged to order directly from their GP practices.

12. The CCG is currently developing an action plan which will examine this issue and proposevarious. A medicines waste communication campaign will begin later this year.

Recommendation

13. Members are asked to note the content of the report.

Greg Mitten

Vice-Chair / Lay member July 2016

Chief Officer’s Update West Lancashire Clinical Commissioning Group Governing Body Meeting – 26 July 2016

1



DATE OF MEETING: 26 July 2016

TITLE OF REPORT: Chief Officer’s Update

BRIEFING POINTS:




Yes


Yes


No

4. Delivering financial balance – please outline impact Yes


No

B. Governance –


provide the Commissioning Board with assurance against any of therisks identified in the assurance framework (identify risk number)



Yes


No

3. Health Inequalities Yes



6. Patient and Public Engagement Yes

REPORT PREPARED BY: Meg Pugh, head of communication and engagement

REPORT PRESENTED BY: Paul Kingan, Deputy Chief Officer/Chief Finance Officer


2

WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHIEF OFFICER’S UPDATE

Purpose

This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting.

House of Commons visit

1. This month two members of our service redesign team were asked to attend the All PartyParliamentary Group on Cancer’s summer reception.

2. The CCG was acknowledged for the fantastic work taking place in the region (incollaboration with Southport & Ormskirk Hospital NHS Trust) around one year cancersurvival rates, of which West Lancashire CCG is one of the leading examples.

Community health services procurement

3. Our community health services procurement continues to progress.

4. Lancashire Care NHS Foundation Trust, Optum Health Solutions (UK) Ltd, Virgin CareServices and Bridgewater Community Healthcare NHS Foundation Trust are having furtherdiscussions with the CCG about community health services.

5. Optum Health Solutions (UK) Ltd and Virgin Care Services are having further discussionswith the CCG about urgent care services

6. It is intended that the successful bidder(s) will be awarded the contract in Autumn 2016 andbegin delivering the services locally in April 2017.

7. Following the second set of Competitive Dialogue discussions with the short-listed biddersat the end of May 2016, the CCG has undertaken further engagement with the residents ofWest Lancashire. Various events have taken place across the localities in communitycentres, village halls, libraries and supermarkets. We been talking to the public around whatthey have previously told us is important to them and how we are proposing to use this tomeasure success as part of the new contract. We are also incorporating what otherstakeholders have previously told us, including local GPs.

8. This insight will contribute to further discussions with bidders as part of the final round ofCompetitive Dialogue meetings which are scheduled to take place in mid July/early August2016.

9. This procurement process is subject to national procurement legislation which requiresCCGs to enable all NHS and private providers to compete. All bidders are evaluated againstset criteria within a stringent process.

10. The CCG has involved several local stakeholders in this process in various ways. TheCCG’s website has a dedicated webpage contains useful resources and information relatingto the process:http://www.westlancashireccg.nhs.uk/have-your-say/community-health-services/

http://www.westlancashireccg.nhs.uk/have-your-say/community-health-services/


3

Transfer of Calderstones

11. Merseycare NHS Foundation Trust has acquired Calderstones Partnership NHS FoundationTrust. The transfer of contracts took place in July 2016.

Well Skelmersdale

12. The CCG continues to work collaboratively on Well Skelmersdale – following our successfulselection as a Well North pathfinder site.

13. Following a visit to Bromley by Bow and a residential workshop with the Well North team,key themes/workstreams are now starting to emerge – enterprise, education, socialprescribing, respiratory health, environment, primary care, NHS estates and communication.

14. A residential follow up meeting took place on 15 July 2016 to explore the progress againsteach of the workstreams.

15. Further updates for the governing body will be provided in the September board meeting.

Strategic Transformation Plans (STP)

16. Draft Strategic Transformation Plans (STP) were submitted to NHS England on 30 June.The plans explain how we can work together over a large geography (typically above a 1.5mpopulation) to help address the gaps we currently see across health and well-being, careand quality, and finance and efficiency.

17. NHS West Lancashire CCG is a full member of the Lancashire and South Cumbria STP andis an associate member to the Cheshire and Merseyside STP.

18. For the Lancashire and South Cumbria plan, the CCG is involved in a number of “out ofhospital” work-streams including prevention, regulated care, prevention, mental health andprimary care.

19. For the Cheshire and Mersey STP, the CCG is involved in the work-streams regarding thepotential re-configuration of hospital services

20. Governance for the STP has been developed and will need final approval by the GoverningBody in due course

21. Formal approval of the STP plans are not required by the CCG’s governing body at thisstage, but we expect that this will be required by September 2016

Recommendation

22. Members are asked to note the content of the report

Paul Kingan Deputy Chief Officer/Chief Finance Officer July 2016

Corporate Risk Regsiter & Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body – 26 July 2016

1

Agenda item no: 07/16/7


DATE OF MEETING: 26 July 2016 TITLE OF REPORT: Risk Register & Governing Body Assurance Framework BRIEFING POINTS: Outlines key risk areas


A. Commissioning Board’s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience)

– please outline impact No

2. Commissioning of hospital and community services – please outline impact No

3. Commissioning and performance management of GP Prescribing – please

outline impact No

4. Delivering Financial Balance – please outline impact No 5. Development of the commissioning group as a commissioning organisation –

please outline impact Yes

Part of governance arrangements

B. Governance – please outline impact 1. Does this report:

• provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number)

• have any legal implications • promote effective governance practice

Yes

Provides overview and updates on all strategic and operational risks 2. Additional resource implications

(either financial or staffing resources) No



5. Clinical Engagement No


REPORT PREPARED BY: REPORT PRESENT BY:

Elizabeth Dalton, CSU Corporate Governance & Risk Manager Paul Kingan, Chief Finance Officer


2

Risk Register & Governing Body Assurance Framework Introduction The Board Assurance Framework (BAF) is a key part of the CCG’s governance arrangements. It is the principal way by which the CCG holds itself to account; it helps to clarify and quantify risks that could compromise delivery of our strategic objectives.

The CCG Risk Register has been reviewed to reflect the up to date position as at 12 July 2016 A separate risk register has been created in respect of the community services re-procurement exercise. This is discussed on a regular basis as part of the Community Procurement Programme Board meetings. The Clinical Executive receives updates on the Community Re-procurement on a regular basis.

Board Assurance Framework The CCG Corporate Risk Register includes 12 risks with a score of 12+ and these have therefore been included on the Board Assurance Framework. Delivery This is the main area of concern for the CCG. There are 9 risks with regards to the achievement of the CCCG Critical Outcome for Delivery. Risk 41 – Increasing financial risk in relation to the CCG taking on specialist services co-commissioning and the associated budget remains a high financial risk to the CCG and an action plan is being developed. The financial year 2016/17 will be about preparation and transition to establish understanding and controls and monitor the impact of delegation commissioning responsibilities. Risk 44 – Risk of main ICO provider failing to meet required levels of delivery and performance. The CCG is working closely with Southport and Formby CCG and Southport and Ormskirk NHS Hospitals Trust on the clinical and financial sustainability of patient services going forward. The governing body will be kept informed as this work progresses. Risk 35 – Service users are potentially at risk of harm due to unlawful deprivation of liberty within hospital care home and supported living. There is a Pan Lancashire action plan in place with LCC being bench marked against national plan held by NHS England. MCA/adult leads of CCGs providing training to CSU staff on DoLS. Risk 29 – IPA process - financial instability, increasing costs, and assurances on quality of assessments. Reviews are being undertaken of high cost complex cases. In-depth examination of the information sent to the CCG by MLCSU is undertaken. The CCG is a member of the IPA Programme Board meetings where Pan Lancashire scrutiny of the IPA process is undertaken. Risk 40 – Patient safety issues in relation to the cardiology services at Southport and Ormskirk Trust having a significant backlog of follow up patients not being offered appointments. Urgent cases have appointments but the majority are still to have their appointments made. Cost of the alternative provision is rising and needs to be managed. Cardiology clinics have been taken off choose and book therefore limited new referrals are being received. The additional capacity is being used to keep the backlog of follow up numbers downs. However of the two new consultants who should have been appointed only one has taken up post and the 2nd post is being re-advertised. Community cardiology services are being developed to deflect work away from secondary care as more cardiology work can be managed in the community.


3

Risk 32 - Patients in receipt of NHS funded care potentially at risk of harm as their health and care needs may not be addressed due to gaps in the commissioning of the CHC service in respect of care planning and case management. Lack of capacity in CHC team resulting in routine reviews behind scheduled. The review process is due to be completed and work with a chosen provider has commenced. The CCG will remain vigilant and monitor progress. Risk 43 - Reduced services provision leading to increase demand on NHS services as a result of £4M cut in public health funding in Lancashire. LCC Cabinet took a paper considering the impact of scaling back to statutory services. This is an area that we are monitoring in terms of LCC decisions and the impact on the CCG. The Council has reserves for 2 years which helps to mitigate against various service budget cuts in the near future. Risk 47 – Risk in relation to unauthorised deprivation of liberty upon discharge when the application is required to go to the Court of protection where significant backlog of applications are being experienced further to a resource being available to manage the volume of applications to the court. A Pan Lancashire working group has been established with multi agency representation. A new risk has been added during the July 2016 review. Risk 50 – No clear case management arrangements for those individuals who may be subject to a domestic deprivation of liberties. The CSU have appointed a lead for quality and safety who will take the lead on the safeguarding arrangements for these individuals. A working group has been established and has involvement of the CSU, CHC and the CCG safeguarding team. Given the current situation the overall risk rating for Delivery is Amber, however this is under constant review as more data on the in-year position for QIPP and financial position becomes available. Engagement Risk 8 - The risk in relation to the lack of engagement of providers in the quality agenda remains at a risk score of 16. Although the CQPG has been reinvigorated by the Trust Executive, engagement from the Trust has been poor and the attendance from Trust Clinicians and GPs has been sporadic. The overall risk rating for Engagement remains at Red. Contracts

There are now two risks on the register with regards to Contracts. Risk 42 – Failure to Achieve Financial Balance 2016/17. The CCG maintain robust financial controls and budget monitoring. Budget holders have been assigned. The CCG will maintain an on-going review of the financial position but pressures on planned care budgets need careful monitoring as they have the potential to have a significant impact on the CCG financial positon. A new risk has been identified under the contracts category. Risk 51 – There are no quality assurance arrangements or contracts in place for individuals in receipt of a CHC funded domiciliary health package of care. The risk is a commissioning gap resulting in a lack of governance arrangements impacting from a safeguarding perspective. There is an increased risk of harm to individuals due to a lack of quality assurance. The CCG safeguarding team work closely with multi agency partners, individuals, and commissioned agencies when safeguarding risks are identified. This is with the aim to improve longer term outcomes and quality for individuals.


4

Operational Systems There are currently no risks in relation to operational systems.

Recommendations The Governing Body is asked to note the board assurance framework and corporate risk register and continue to support the risk management arrangements. Paul Kingan Chief Finance Officer July 2016

West Lancashire CCG - GBAF - July 2016

West Lancs CCG - GBAF 12 July 2016 1

Assurance Framework 2016/17 - V1.2 July 2016

Risk

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Critical Outcome/Strategic Objective Description of Risk Controls to Mitigate Gaps in Control Assurance on Controls Gap in Assurance Cu

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These are the specific areas where failure will risk a critical outcome

Processes and plans in place or actions being taken to mitigate risk in principle areas

Areas where controls are not in place or are ineffective

Internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective

Areas of insufficient evidence to assure the Governing Body that controls are being effective

Key actions being taken to mitigate the risk

See Key

44

11.0

8.50

15 Delivery - Failure to Deliver CCG Service

Priorities

Risk of main ICO provider failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook

and senior staff changes.

Discussions at Quality Committee, discussions with Chair of hospital and

Board to Board meetings. Achievement of contract performance

targets.

Performance data often retrospective and time lag exists. Queries and letters

not responded to on time.

CCG continues to meet regularly with the Trust at a number of meetings (around quality and

contractual performance), as well as a dedicated health economy wide group which meets regularly and

looks at clinical and financial sustainability of services going

forward. This includes NHS England, the TDA and fellow CCG

commissioners. This work has been given a high priority in each

organisation.

Some services difficult to performance monitor on timely basis e.g. Community Services

4 4 16

Regular bi-weekly meetings of the Trust sustainability programme

which involves all key stakeholders. The risk score will likely stay the

same until longer term solutions are found.

Jul-16

50

16.0

6.16 Delivery - Failure to

Deliver CCG Service Priorities

There are no clear case management arrangements for those individuals who may be subject to a domestic DoL There is no

oversight of individuals resulting in potential safeguarding risks and people being subject to an unauthorised DoL.

The CSU have appointed a lead for quality and safety who will take a lead on the safeguarding arrangements for

these individuals.

No clear documented case management. Appointment of CSU lead for quality

& safety to ensure safeguarding arrangements are in place.

Resource requirements need to be established.

4 4 16

Working Group to establish resource requirements, documentation

support and training arrangements for staff.

Jul-16

35

31.1

0.20


Priorities

Services users are potentially at risk of harm due to unlawful deprivation of liberty within hospital care home and supported living following the Cheshire

West Judgement in March 2014.

Pan Lancashire action plan in place with LCC being bench marked against

national plan held by NHS England. MCA/adult leads of CCGs providing

training to CSU staff on Dolls.

Timely notification and management of cases where application to Court of

Protection may be required. CSU has no access to Broadcare to

identify patients.

Minutes from Pan Lancs Group to feed into S/G Assurance Group; Pan

Lancs S/G Collaborative and Advisory Group (now ceased)

LA Plan to be shared with health interaction into this plan agreed.

CSU Broadcare Reports. Action plan re management of fall-

out from Cheshire West to be developed.

Pan Lancashire Group established.

Case Management with CHC function to undertake required

reviews. No legal expertise and capacity

within the CCG to make applications to the Court of

Protection. Legal advise being sought on a case

by case basis.

3 4 12

Seek assurance that the care and treatment plans for CCG

commissioned packages of care for individuals lacking capacity to

consent have been reviewed and where a DoLs is identified full

exploration of alternative ways of providing care/treatment have been

undertaken to enable the least restrictive option of care. Seek

assurance from care homes where there are CHC funded patients that

DoLs applications have been made or are in the process of being

authorised. CCG to determine which service is best placed to be

commissioned to case manage CHC patients residing in their own homes

and supported tenancy to ensure compliance with Cheshire West

recommendations.

Jul-16



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29

31.0

7.20


Priorities

IPA process - financial instability, increasing costs, and assurances on quality of assessments

Reviews of high cost complex cases.Examining the information MLCSU

sends to CCG.Undertaking further training for GPs

on process.Participation at IPA Programme Board

meetings

None identified at present IPA Programme BoardTesting of new Governance

Structure to see if assurance is relevant and being managed.

4 3 12

Continued scrutiny of CSU Broadcare data. Development of new

commissioning process. The CCG has accepted the CSU's QIPP proposal - this will increase the capacity of the CSU IPA team and the frequency of case reviews. The CCG's investment is anticipated to be more than offset by the savings made. Following the

recent procurement of the CHC Framework Agreement the CCG is

anticipating a significant increase in the weekly rates care homes charge

(the median increase across Lancashire is 10.5%)

Jul-16

40

11.0

2.20


Priorities

Patient safety issues in relation to the cardiology services at Southport and Ormskirk Trust having a significant backlog of follow up patients not being

offered appointments.

Alternative provider commissioned to resolve backlog.

No oversight of discussions with providers.

Urgent cases have appointments but the majority are still to have their

appointments madeCost of the alternative provision is rising and needs to be managed.

Detail of discussions with the provider is still not clear and needs

to be confirmed. 4 3 12

Cardiology clinics have been taken off choose and book therefore limited new referrals are being

received. The additional capacity is being used

to keep the backlog of follow up numbers downs.

However of the two new consultants who should have been appointed

only one has taken up post. Post is being re-advertised.

Community cardiology services are being developed to deflect work

away from secondary care as more cardiology work can be managed in

the community.

Jul-16

32

30.1

0.20


Priorities

Patients in receipt of NHS funded care potentially at risk of harm as their health and care needs may not

be addressed due to gaps in the commissioning of the CHC service in respect of care planning and case

management. Lack of capacity in CHC team resulting in routine reviews behind scheduled.

CSU commissioned to manage CHC process. Monthly exception reporting

care homes from CSU. Quarterly reporting on CHC from CSU

No oversight of CSU funded services.

In view of a 16 -20% increase in demand for CHC assessments the CSU Board has made additional funding available to procure the support of an external nursing

company to assist in the complete CHC reviews.

IPA Programme Board.

Lack of capacity in CHC teams. 4 3 12

The review process is due to be completed and work with the chosen

provider will commence within the month. West Lancashire CCG and BWD are the first CCG areas to be

targeted, reviews are expected to be completed by end March 2016. In light of the addition resources the

risk is reduce to moderate.

Jul-16



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30.0

6.20


Priorities

Increasing financial risk in relation to the CCG taking on specialist services co-commissioning and the

associated budget.

2016/17 will be about preparation and transition to establish understanding

and controls.

Impact of specialist services co-commissioning not fully known

Issue around bariatric is still not resolved. A solution is being worked up across CCG’s in Merseyside and Lancashire. This is being managed via the Lancashire Collaborative

Commissioning Board of which the CCG is a member. Still remains a

high financial risk to the CCG. The NHS will provide a procurement

proposal and project plan which is likely be on a North West footprint.

NHS Procurement Plan 4 3 12Action plan need developing as likelihood that financial risk will

increase during 2016/17. Jul-16

43

18.0

6.20


Priorities

Reduced services provision leading to increase demand on NHS services as a result of £4M cut in

public health funding in Lancashire

Chair of HWN Board has written to the Secretary of State on behalf on the

Board.None identified at present

Lancashire Health & Wellbeing Board to have discussion to

determine what it will mean for the future of Public Health.

That any soft evidence on the impact of local authority cuts should

be forwarded to Director of Public Health

None identified at present 3 4 12

LCC Cabinet took a paper considering the impact of scaling back to

statutory services. This is an area that we are monitoring in terms of LCC decisions and resulting impact.

Continue to monitor any impact through comments received by the

CCG.Liaison with LCC commissioning leads to ensure CCG exec and Membership

are briefed on updates regarding mobilisation of newly awarded

contracts.

Jul-16

47

26.0

2.20


Priorities

There are concerns around MCA and DoLs quality assurance arrangements & compliance in relation to those patients

diagnosed with learning disabilities currently detained in secure settings where arrangements are being made for discharge as

directed by Transforming Lives agenda. The risk is around unauthorised deprivation of liberty upon discharge when the

application is required to go to the Court of protection. A significant backlog of applications are being experienced further

to a resource being available to manage the volume of applications to the court.

Patients currently remain under section of the mental health Act whilst

arrangements are being considered.

Case Management with CHC function to undertake required reviews.

No legal expertise and capacity within the CCG to make applications to the Court of

Protection. Legal advise being sought on a case by

case basis.

Law Commission Review is still outstanding. The CCG is unable to take any further direct action until

the review has been completed.

The CSU are recruiting a Learning Disability Clinical team to case manage these patients during discharge and identify those

patients who will require a DoL .

4 3 12

The CCG Safeguarding Team are involved in a Task & Finish Group with the Quality & Effectiveness

Team. Work plan and priorities to be agreed.

Jul-16

8

01.0

4.20

15 Engagement - Failure to Engage Effectively

with Stakeholders

Lack of engagement of providers in the quality agenda leading to a lack of understanding and

consistency between partners regarding outcomes of specific schemes.

CQPG has been reinvigorated but Trust Executive engagement from the Trust

has been poor

New meeting is in place to engage Trust clinicians with GPs. JC attends on

our behalf.

Separate single item QSGs have taken place to focus trust on quality issues

More detailed requirements of funding and scheme outcomes are being

stipulatedSeparate meetings with other providers

have taken place to iron out quality issues

Regular feedback of new “op forum” to membership under chairman’s update

CQPGEngagement of trust staff with GPs in our membership and FTFT events

4 4 16

Continued emphasis on the quality agenda at the QSG meetings and

with formal letters between the CCG and S&OHT on these issues.

Jul-16



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16.0

6.16

Contracts - Failure to effectively manage contracts to ensure high quality services

There are no quality assurance arrangements or contracts in place for individuals in receipt of a CHC

funded domiciliary health package of care. The risk is a commissioning gap resulting in a lack of governance

arrangements impacting from a safeguarding perspective. There is an increased risk of harm to

individuals due to a lack of quality assurance.

The CCG safeguarding team work closely with multi agency partners,

individuals, and commissioned agencies when safeguarding risks are

identified. This is with the aim to improve longer term outcomes and

quality for individuals.

CSU complex cases team are sign off individual packages of care once a care

plan has been presented and meets needs.

Lack of governance arrangements when monitoring the ongoing packages of care

or when an individual needs change.

CSU Safeguarding team work closely with multi agency partners.

Limited resource available to provide the ongoing review of

packages from the complex cases team.

5 4 20

Paper to be submitted to the collaborative commissioning board

to highlight the risk and agree future actions to minimise.

Jul-16

42

01.0

4.16

Contracts - Failure to effectively manage contracts to ensure high quality services

Failure to achieve Financial Balance 2016/17

Robust financial controls (ledger) and budget setting.

Budget holders assigned.Budget allocation agreed by DoH for

2016/17.

None identified at presentMaintain an on-going review of

financial position.

Planned Care Budgets need careful monitoring due to potential impact

on CCG financial position. 4 3 12

Continuous monitoring of financial position. Successful implementation

of QIPP Schemes.Jul-16

Operational Systems No risk recorded

Assurance Status Key:Green Complete

Amber On track

Red Off target

West Lancashire CCG Risk RegisterCLOSED Risks - as at 06.11.15Risks removed from the active register

Lead Description ControlsOverall

Risk Score

Action Plan (AP) Updates Residual risk

Link to BAF C L R A G

1BAF Theme: KW

The Central Support Unit (CSU) do not the have the capacity /capability to ensure the CCG can fulfil statutory duties

i) Regular discussion with CSU regarding the on-going position

Continue to manage on a week by week basis during transition

Regular liaison with CSU maintained. Low

ii) CSU seeking specialist advice to address gaps in service offer

Maintain contract for specialist cover in the interim

Operational Systems

Interim specialist staff recruited by CSU for health and safety, fire and risk management.

ii) CCG have contracted specialist support directly in short term

Development of suite of policies.

Robust CSU support now in place

Inspections completed and reported to Audit Committee. No significant issues

Development of suite of policies nearing completion

2BAF Theme: JW

Impact of shortfall in recruitment to the CSU in terms of specific support posts

i)Good liaison with CSU regarding gaps in recruitment

Continue to manage on a week by week basis

Embedded team is now fully established and residual issues regarding hub functions are resolved

Low

Operational Systems

When vacancies arise any short term pressures are covered

3BAF Theme:

Contracts/Delivery

JM

The business intelligence information provided by the CSU is

insufficient for the CCG to make informed decisions. Monitoring of key performance indicators inc resilience & recovery planning.

i) KPIs are agreed and monitored for each contract. Quality Improvement Committee

collecting information from various data streams

ii) Direct feedback reports from secondary providers re trends

iii) Informal GP sharingiv) Lead Nurse in post

3 2 6

Data flows are established but still not

yet embedded.Non specific gaps as

follows: i) Lack of clarity of

future role of NHSE in managing and

influencing the system

Establish clarity of reporting activity

arrangements - quality processes now working

wellFeedback to CSU on the areas that we require

making more robust. On-going review – Jan 15

Low/Moderate

4BAF Theme: KW

Limited GP capacity to the CCG results in increased management

costs and/or limited involvement in local meetings and groups

i) Specific GP portfolios supported by CCG managers 3 2 6

Planned improvements to communications

pathways to improve efficiency,

Planned improvements to communication pathways to improve efficiency. On-

going development of engagement strategy will target better use of GP capacity – Facing the Future Together has

produced a strategy – Risk Closed – Jan 15

Low/Moderate

Score Status of AP

33 1

33 1

Operational Systems/

Engagement

ii) Planning of GP engagements to ensure maximum benefit for

CCG

On-going development of engagement strategy will target better use of

GP capacity.Continue watching brief

5BAF Theme: PJ 2013/14 Financial shortfall possible

due to:

i) On-going verbal assurances regarding the system wide allocation issues

Regular dialogue and updates on a weekly basis

CCG confident of operating within budget for 2013/24

Low

Contracts/Delivery

i) Reduction in allocation following redefinition of specialised services may compromise ability to meet contract costsi) Disaggregation of budgets from CLPCT

ii) Agreement with Chorley and Gtr. Preston CCGs regarding reallocation of resources

Lancs wide agreement achieved regarding allocation for 2013/14

Status reduced to low for this financial year

6BAF Theme: PJ

Limit on running costs resulting in lack of flexibility to manage staff shortages in financial dept.

i) Establishment is considered appropriate to meet current needs

Regular monitoring of staffing levels and capacity

Finance team fully established Low

Operational Systems

ii) Staff encouraged to work flexibly to ensure adequate cover

Examine development of matrix working to mitigate impact of staff shortages

No current pressures status remains satisfactory

Continue watching brief Risk reduced to low

For 2013/14 only

9BAF Theme:

MM(KW)

On-going pressure from MPs and interested parties to provide

information

Websi8te & Media Coverage. Public Board Meetings & joint

networking.

Additional target group contacts obtained via AGM and on-going engagement work.

Contacts continue to be gathered for the

stakeholder database.

Engagement Patient Participation Groups

Patient Focus GroupsMg View Group

Stakeholder Database established and MP relationship good at present time – Risk

Closed Jan 15

10aBAF Theme: JM

Unclear system and process to ensure the CCG receives critical timely information relating to SUIs.

i) Existing systems established in providers for management of SUIs.

Increase understanding of existing structures & systems within commissioning and providers

Information flow arrangements agreed

Contracts/Operational

Systems

ii) Handover meetings in place

Establish systems to ensure appropriate information flows and governance arrangements are in place

Chief Nurse and Quality Assurance Manager now in post

3 1 3

Low

Moderate

33 1

3 2 6

Co-ordination of information flow

between key stakeholder groups needs improving

4 1 4

10aBAF Theme:Contracts/Operational

Systems

JM

Individual Funding Request and Continuing Healthcare Requests involving WL patients.(REPLACED WITH RISK 29)

i) Existing systems established for management of IFRs & CHRs 3 3 9

Ensure appropriate data is in place for IFRs and CHCs so that the CCG can appropriately monitor process and performance

Information flow arrangements need to ensure adequate data regarding IFRs and CHRs.

Low/Moderate

10b JMLack of nursing input into quality, safeguarding and SUI operational systems

i)Development of robust quality to identify gaps

Link with Chief Nurse from neighbouring CCG to ensure links re SUIs

Chief Nurse and Quality Assurance Manager now in post

Low

BAF Theme:Contracts/OP Systems

ii) Regular reporting to Quality Committee of safeguarding/SUI and all quality metrics

Advertisement for additional nursing/quality posts in process

Reduce risk to low

11BAF Theme: KW

Ability to manage the gap in knowledge transfer during the transition process from PCT to CCG

i) attendance at transition/closedown group

Maintain contacts with PCT, services and other agencies during and after transition

Issues relating to knowledge transfer have now been resolved and no new issues have been raised.

Low

Delivery/Contracts/Operational

Systems

ii) Handover meetings scheduled

Maintain broader overview of developments to avoid unexpected problems

Risk reduced to low

iii) Legacy document re. service/agency specific knowledge & contacts

12BAF Theme:Operational

Systems

KW Lack of CCG business continuity plan

i) Currently linked to PCT continuity and recovery plans 3 1 3

Develop CCG specific continuity and recovery plans in liaison with partners and stakeholders

CSU Business Continuity Plan now received and both plans circulated to all relevant parties

Low

13 JWManaging the demands of the Local Area Team (LAT) regarding the performance of CCG contracted services

i) Established links with LAT 2 2 4Develop open culture with LAT regarding performance issues

Continuing dialogue current relationship is very positive.

Low

BAF Theme:Contracts/Delivery/

Engagement

ii) Agreement with LAT regarding CCG Annual Plan

Ensure strong links with other CCGs is maintainedSeeking to improve data around quality of GP services

Status remains satisfactory

14 JWPossible breaks in continuity of contracted services during and post transition

i) Comprehensive database of contracts in place 3 1 3

On-going verification of data relating to all contracts during transition

All contracts now in place and any transition issues resolved

Low

BAF Theme:Contracts/

Delivery

ii) PCT support to ensure all contracts are handed over to plan

15BAF Theme:Contracts/

Delivery

JWInherited risk from PCT- Lack of governance in the Brief Therapy Support Services.

i) Issues being investigated by former CL PCT CCGs 3 1 3 CCG have fully

investigated the issues.

Any issues have been resolved and sound governance arrangements are in place

Low


Systems

KWPotential impact on delivery of corporate and legal responsibilities arising from pressures on capacity.

i) CCG fully established with clearly defined roles

Robust prioritization process to be developed in relation to key priorities

New risk added December 2013) Moderate

Links to No. 21 ii) Matrix working principles established

Time management and resilience training to be developed to embed effective working practices

Prioritisation for 2014/15 needs to be progressed.

(Risk closed as relates to 2013/14) iii) PDP process in place 1-1 process in place.

iv) Informal staff and senior team meetings

PDR process about to commence for 2014/15

4 2 8

4 1 4

3 1 3

17BAF Theme:

Contracts/Operational Systems

CH

Failure of the CSU and hosted services to provide robust arrangements for meeting statutory duties relating to

safeguarding.

i) Hosted Services in place

Hosted Services proposals considered via Lancs CCG Chairs network – no agreement yet reached

Chief Nurse is now leading in this area.

Low/Moderate

ii) CSU proposalsCSU proposals via CCG managers meeting – no agreement yet reached

Multi CCG task and finish group has been established. Chief Nurse attends.

Multi CCG task and finish group to be established

Draft Safeguarding Policy received and awaiting approval at next quality committee.

Processes now in place. Risk mitigated and closed.


Systems

MM

Reduced prescribing capacity due to Lancashire Area Team (LAT) having no process in place to authorise practice based non-medical prescribers (NMP) to have prescription pads

Letter sent to LAT requesting they establish standard operating

procedures for registering new NMP with the prescription pricing division and implementing the required checks prior to issuing

prescriptions.

2 3 6 To monitor LAT’s response to letter sent

New Risk added 23.1.14Awaiting LAT response as at 6.3.14

Low


Systems JM

Failure to maintain equipment asset register by Lancashire

Teaching Hospitals for equipment issued re complex packages of care

Inform Chorley and South Ribble CCG (host CCG) and request they discuss issue at contract meeting re incident reporting and informing the CSU immediately so investigation can be undertaken.

3 3 9

Network Director contacted to discuss

procedure. Issue to be raised with CSU. Ensure procedure reviewed with

regard to incidents where CSU needs to be

informed.

CSU seeking to procure new equipment asset and maintenance system. The CCG is progressing this

issue with the CSU – Jan 15.

Risk removed from register on

8.6.15

20 PJ Not achieving financial balance in 2014/15

i) Financial system to take corrective action as required

Financial plan in draft Risk added 13.3.14 Low

BAF Theme:Contracts/

Delivery

RISK IS DUPLICATE OF 26 SO CLOSED


Systems

PJ i) Current position on running costs known

Plan for 15/16 being prepared Low/

ii) Plan for 15/16 being prepared Moderate

1)Monthly review meetings with nurse specialist

Meeting 22.7.14

2)Bi monthly meetingTrust to provide paper of up to date activity and risk.

With senior team Low

3)Process map September

4)Review Spec in August

4 1 4

4 2 8

4 2 8

Potential impact of 10% Reduction in running cost allocation from

2015/16

Cost allocation plan being prepared for 2015/16 –

Risk removed as incorporated into Risk 25

To continue with controls23 CMC

The Oxygen Service provided by Southport and Ormskirk Hospital Trust has a waiting list of existing patients to be reviewed

2 3 6

24BAF Theme:Engagement

MMLack of Engagement with NHS England Primary Care Teams

Regular meetings between chief officer and deputy primary care lead at LAT

Primary care issues raised at CCG and LAT quarterly

assurance meetingChief officer has regular 1:1s with chief executive of LAT

4 2 8

Significant issues arising from 1:1s

between chief officers and LAT to be

reported to the governing body within

the Chief Officers Report as from July

2014

Issue compacted with merger of NHS England

Area Teams.Concerns continue in relation to capacity to

fulfil any co-commissioning

requirements. Decision being made by the

Membership Council early January 2015 over

the level of Co-commissioning the CCG wished to take on. Jan

15.

Moderate

26BAF Theme:

ContractsPJ

Failure to Achieve Financial Balance 2014/15

Robust financial controls (ledger) and budget setting.

Some budget holders assigned.

Budget allocation agreed by DoH for 2014/15

4 2 8

Continuous monitoring of

financial position. Successful

implementation of QIPP schemes

On-going review of financial position – Jan

15.

Risk removed from register

on 8.6.15.

Moderate

28BAF Theme:

DeliveryKT

Uncertainty of future of CCG affecting ability to plan long

term

5 year plan finalised & submitted.

Strategic Partnership in place.Governing Body development workshop on strategic position

held.

3 3 9

5 year plan submitted and feedback

received. Risk reduced from (4x3) 12 to (3x3)

due to potential political impact

Facing the future together (FtFT) transformation

programme in place. Outcome of Gateway 1 resulted in RAG Rating of Red / Amber. Letter and Gateway Report

sent to S&O Trust outlining the current

position. Second Gateway is scheduled

for March 2015. Update Jan 15.

Risk removed from register

on 8.6.15. Risk around delivery of FFT remains

on register.

Moderate

30BAF Theme: Operational

Systems

Lack of approval/ Risk added July 2014.

implementation of an IM&T Strategy

2 3 6

Strategy approved at November 2014 GB

ModeratePK

IM&T strategy agreed in principle by CCG.

Strategy has been circulated to partner organisations.

Each member practice has an agreed programme plan

To review all feedback from circulation of

Strategy with partner organisations prior to full implementation.

Strategy being presented to governing

body for formal adoption in November.


Systems

Receive information via the CSU on all incidents reported in nursing homes. Incident

dashboard being developed. Chief nurse attends RADAR meeting with local authority Regular

attendance at Safeguarding Adult Board meetings.

Risk added July 2014.

Chief nurse meets fortnightly with safeguarding team.

Risk can now be closed as process strengthened in relation to care homes.

37BAF Theme:

Delivery

Provider has duty of care to patient.

CSU and provider meetings taking place.

Risk added October 2014

Request made to the CSU IPA team in relation to this new incident. CSU have stated that they

have no concerns regarding the safety of

this patient but are working with the provider

to resolve.Identified Risk now Closed – Jan 15.

39BAF Theme:

DeliveryMM/JM

Inappropriate placement of individual learning disability patients following Learning

Disabilities – Enhanced Support Service (LD ESS) being

transferred to CCGs as a result of CCG not having the expertise

in this area.

Further discussion at CCB meeting

3 3 9

July 15 Update - No progress with this

issued – risk unchanged.

Lead manager in post with a focus on LD -

Risk Closed - Jan 2016Medium \High


Systems

PK

Implementation of the new IT system at S&O as it may affect the delivery & quality of health

services

Monitoring of performance and quality metrics for all

metrics so any changes can be identified.

Updates on implementation going to SPB.

Contract penalties for non- submission of data.

4 2 8

On-going monitoring of performance &

quality metrics. CCG IT lead obtaining a status

report.

Data checks have been done and the CCG is

now satisfied that the new system has

bedded in appropriately. Risk Closed - Jan 2016

Moderate

9

Medium /HighPJ

Provider has given formal notice to CSU (28 day standard NHS

Contract) re patient on Sec 3 MHA as unable to meet patient's needs.

Vulnerable patient, risk of absconding risk to self and others

as well as a risk of self-harm.

4 3 12

The CSU IPA team are responsible for placing patients on behalf of the CCG. CCG to ascertain from the CSU IPA team why there have been a delay and when will they source a more suitable placement for the patient.

CHLimited assurances on nursing

home issues, -potential Safeguarding issues not identified

Southport & Ormskirk Trust to amend Policy to

ensure staff report incident relating to

Nursing Home patients. Awaiting confirmation

that this has been done

Moderate3 3

Integrated Business Report West Lancashire Clinical Commissioning Group Governing Body meeting – 26 July 2016


WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERING BODY REPORT

DATE OF BOARD MEETING: 26 July 2016 TITLE OF REPORT: Integrated Business Report BRIEFING POINTS: This report provides summary information on the financial

and activity performance of West Lancashire Clinical Commissioning Group for May 2016 and a financial position for June 2016. Quality and performance analysis is also provided for community based targets and for the Southport and Ormskirk Hospitals.




Yes

The report outlines quality and performance issues relevant to the CCG and describes key actions to address these.


Yes

The report includes financial and activity information in relation to commissioned services and highlights areas of risk and actions.


No

4. Delivering Financial Balance – please outline impact Yes

The report summarises the financial position of the CCG and highlights areas of financial risk.


Yes

This report will support the CCG in developing clear and credible plans.

B. Governance – please outline impact


provide the Commissioning Board with assurance against any of the risks identified in the assurance framework



Yes

Links to financial risks.


No


Links to health outcomes framework (all five domains)


5. Clinical Engagement No


REPORT PREPARED BY: Paul Kingan, Chief finance officer

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West Lancashire Clinical Commissioning Group Integrated Business Report

July 2016 (Reporting Period May 2016)

3 | P a g e

TABLE OF CONTENTS 1 Executive Summary 3

2 Financial Position 4

3 QIPP 7

4 Planned Care: Referrals 8

5 Planned Care: eReferrals Service 9

6 Planned Care: Acute Contract 10

7 Unplanned Care: Acute Contract 11

8 Prescribing 13

9 Lancashire Care Foundation Trust (LCFT) Activity 15

10 Quality and Performance

a WL CCG Performance Dashboard 18

b Southport & Ormskirk hospitals NHS Trust Integrated Performance Dashboard 22

c Areas of Under-Performance 24

d Patients Waiting by Weeks 26

f Friends & Family Test 28

g Safety Thermometer

29

11 Complaints

GP Comments, Concerns & Issues with Healthcare Providers 29

12 Serious and Untoward Incident Reporting

30

4 | P a g e

1. Executive Summary This report provides summary information on the activity performance of West Lancashire Clinical Commissioning Group for May 2016 and a financial position as at June 2016. Quality and performance analysis is also provided for community based targets and for Southport and Ormskirk Hospitals NHS Trust.

CCG Position Highlights

OVERALL POSITION Footprint CCG delivery of financial duties CCG CCG forecast CCG DEMAND GP referrals CCG Other referrals CCG PLANNED CARE Total planned care PBR CCG UNPLANNED CARE Total unplanned care PBR CCG PRESCRIBING Prescribing Budget CCG

CCG Key Performance Indicators YTD

NHS Constitution indicators Footprint

RTT 18 Weeks wait (admitted) CCG

A&E 4 hours CCG

Cancer Waits 62 days CCG

Ambulance Category A Calls CCG

Other key targets

Friends and Family CCG

MRSA attributable to CCG CCG

C. difficile CCG

Cancer 14 day urgent target –breast CCG

Key information from this report

NHS West Lancashire CCG

As at June 2016 the CCG is forecasting a surplus of

£1.510m, in line with the 1% target (£1.510m) required

by NHS England.

Indicative performance to the end of May 2016 against

the planned care element of all contracts is under plan

by £90k.

The performance over the same period against the

planned care element of the Southport and Ormskirk

contract only is under plan by £207k.

Indicative performance to the end of for May 2016

against the unplanned care element of all contracts is

over plan by £339k.

Unplanned care performance for the same period

against the Southport and Ormskirk Hospital contract is

over plan by £198k.

Performance issues

The CCG has again under achieved on Ambulance -

All Category A call out indicators.

The 4 hour A & E target continues to be an issue with S

& O, Wrightington, Wigan and Leigh and Lancashire

Teaching Hospitals Trusts all failing the 95% target.

The cancer 62 day and 2 week breast targets are

underperforming as are 2 of the 31 day cancer targets.

5 | P a g e

2. Financial Position The following table summarises the financial position for West Lancashire CCG at Month 3 2016/17.

Budget Expenditure Variance Budget ForecastForecast

Variance

£000 £000 £000 £000 £000 £000

Acute services

Acute 19,831 20,088 257 79,072 79,329 257

Ambulance services 778 778 - 3,113 3,113 (0)

Sub-total Acute Services 20,609 20,866 257 82,185 82,442 257

Mental Health Services

Mental Health 2,738 2,738 - 10,751 10,751 0

Learning Difficulties 351 351 - 1,403 1,403 -

Sub-total Mental Health Services 3,088 3,088 - 12,154 12,154 0

Community Health Services

Community 3,926 3,926 - 15,704 15,704 (0)

Sub-total Community Services 3,926 3,926 - 15,704 15,704 (0)

Continuing Care Services

Individual Packages 2,498 2,498 - 9,513 9,513 -

Funding Nursing Care 230 230 - 919 919 -

Sub-total Continuing Care Services 2,728 2,728 - 10,433 10,433 -

Primary Care Services

Primary - Local Enhanced Services 274 274 - 1,095 1,096 1

Urgent Care 358 358 - 1,432 1,432 -

GP IT 146 146 - 585 585 -

Prescribing 4,895 5,034 138 19,315 19,453 138

Sub-total Primary Care Services 5,673 5,812 138 22,428 22,566 139

Other Budgets/Reserves

Running Costs 593 593 - 2,370 2,370 -

NHS Property Services 215 215 - 859 859 -

Other Corporate Costs 239 239 - 955 955 -

Other Programme Services 343 343 - 1,372 1,372 0

Seasonal Resilience - - - - - -

Non Recurrent Schemes - - - 1,471 1,471 -

Contingency 396 - (396) 755 359 (396)

Reserves - - - (1,221) (1,221) -

Sub-total Other Programme Services 1,785 1,389 (396) 6,561 6,166 (395)

Total - Commissioning services 37,810 37,810 0 149,465 149,465 0

Planned Surplus 377 - (377) 1,510 - (1,510)

Grand Total 38,187 37,810 (377) 150,975 149,465 (1,510)

Year to Date Full Year

NHS West Lancashire CCG

Financial Position as at Month 3 2016/17

6 | P a g e

As at Month 3 the CCG has a year to date underspend of £0.377m, which is forecast to increase to £1.510m by the end of the financial year. This is consistent with the delivery of a 1% surplus as required by NHS England. Key points to note are: Acute Services – Initial Month 2 activity monitoring information indicates significant year to date overperformance with certain providers most notably Wrightington, Wigan and Leigh NHS Trust and Ramsay Healthcare. The value of non elective activity with the former is already in excess of £100k above planned levels, predominantly relating to General Medicine and Trauma & Orthopaedics. Elective and outpatient activity across a range of specialities accounts for a £164k year to date overperformance at Ramsay Healthcare. As limited data (for only two months) is available at this stage in the financial year, the forecast represents the year to date position and is not based on an extrapolation. Performance information will be closely scrutinised in the coming months for evidence of developing trends that may have a material financial implication. Prescribing – The performance of the Prescribing budget, and the delivery of planned QIPP savings of £835k, will be critical to the CCG delivering its financial targets in 2015/16. Although a forecast for the 2015/16 financial year has not yet been produced by NHS Business Services Authority, the CCG is concerned that expenditure for April is 10.3% greater than the equivalent month last year. This is considerably higher than the Lancashire average of 2.0%. A £138k overspend has been included in the position but, as with Acute Services, this has not been extrapolated whilst additional iterations of the data are awaited.

1% Non Recurrent Reserve - The CCG is required to set aside 1% of its programme allocation for this. In a departure from previous financial years, HM Treasury has stipulated that all commissioning organisations must ensure that this reserve is fully uncommitted at the start of the financial year. By commissioning organisations not committing their 1% monies this creates approximately £800m of additional headroom to mitigate financial risk in the overall NHS position. Approval for spending of the 1% non-recurrent monies during the year will also be subject to approval by HM Treasury but this will be contingent on the outcome of a review of the in-year NHS financial position. Reserves – Included within this figure are negative budgets (and associated planned savings) relating to QIPP schemes that have not yet been applied to individual operational budget lines. Examples of such schemes are Outpatient attendance reductions and the redesign of MSK pathways. These budgets will be transferred out of Reserves when the CCG has greater certainty of the impact of the schemes on specific provider contracts.

Contingency – The CCG is holding 0.5% of its allocation as a contingency (as per NHS England’s 2015/16 Business Rules). Given the year to date pressures on Acute Services and Prescribing, £396k of this contingency has already been deployed to deliver a balanced financial position as at Month 3. The CCG is conscious that this represents the use of more than half of the contingency an an early stage in the financial year. Accordingly it has infomed NHS England of a deterioration to its risk adjusted position (i.e. the position if certain financial risks were to crystallise) to a £400k deficit - previously this was breakeven.

7 | P a g e

The CCG’s annual budget as at Month 3 is £150.975m. This is derived as follows:

In addition to its duty on delivering a 1% surplus the CCG has other financial responsibilities:

Better Payment Practice Code (BPPC) The Better Payment Practice Code requires the CCG to aim to pay valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The CCG’s target is for 95% of invoices (both by value and volume) to be paid within this criteria. Below is the 2016/17 cumulative performance against these requirements:

Cash Management

The CCG must not utilise more cash than it has available, both on a monthly and annual basis. It has to manage its cash flow accordingly whilst ensuring there are sufficient funds available to pay suppliers and meet the BPPC targets listed above.

NHS England issued the CCG with a Maximum Cash Drawdown (MCD) for 2016/17 of £149.189m 3. QIPP

£000

Opening Programme Allocation 146,593

Opening Running Cost Allocation 2,370

Return of 2014/15 Surplus 1,464

Recurrent 2015/16 Adjustments (post Allocation Setting) 488

Eating Disorders 60

Total resources (as at Month 3) 150,975

Target

Cumulative

Performance

to date

On Target

for Year

End

Value 95% 98.37

Volume 95% 99.44

Value 95% 99.93

Volume 95% 99.82

NHS

Non-NHS

£000

Maximum Cash Drawdown 2015/16 149,189

YTD Cash Drawdown 30,750

CHC Risk Pool Contribution 94

YTD Oxygen and Prescribing 4,772

Cash Available for Remainder of Year 113,573

8 | P a g e

Each year the CCG is faced with balancing the rising demand for services with a finite amount of resources. Therefore the CCG seeks to negotiate the best value for money it can achieve from its contracts, whilst also seeking to achieve Quality, Innovation, Productivity and Performance (QIPP) gains. These savings maybe either cash releasing or non-cash releasing but need to have a recurrent effect if the CCG is to see a sustainable financial benefit. 15 QIPP schemes have been identified for 2016/2017 and a description, expected savings, confidence levels, current indicative savings and project status for each are shown in the table below.

The figures shown in the table above will continue to be reviewed, refined and updated as the schemes develop and further analysis of supporting data is carried out. More sophisticated analysis will take place as the year progresses and more data on the performance of schemes becomes available to the CCG. 4. Planned Care: Referrals

Expected

Savings

Likelihood of

savings being

delivered

Likely

Savings

£k % £k

1 PrescribingSavings from more efficient and effective prescribing of

medicines835 90% 752

2 Right Care Right ValueSavings identified from the Right Care opportunities

analysis265 70% 186

3 Outpatient attendance reductionsSavings from reduction in outpatients as a result of

improving first to follow-up ratios165 70% 116

4 Estates reviewReduction in the costs of running estates and better

util isation100 50% 50

5 Contract coding challengesChallenge coding for outpatient Orthopaedic

procedures375 90% 338

6 Packages of Care review Reduction in CHC placement costs 325 90% 293Obtain accurate monitoring data from M&L

CSU

7 Musculoskeletal Redesign ProjectSavings from referrals, inpatient and follow-ups

avoided449 80% 359

8LD Discharges to community

placementsReduction in LD case costs 375 70% 263

9 COPD Savings in complex cases 340 80% 272

10 Primary Care (Care Homes) Reduce urgent care costs 125 75% 94

11 IT Strategy Schemes FLO Telehealth - reduction in patient admissions 60 50% 30

12 Other Non Elective Schemes Includes Acute Visiting Service 384 50% 192

13 Community Gynaecology Service Scheme in development 50 50% 25

14 Community Dermatotogy Service Scheme in development 50 50% 25

15 Revised IPA System Develop discharge to assess service model 250 50% 125

4,148 75% 3,117

ID Scheme Name Description Task

Total

9 | P a g e

The following section provides an overview of Referrals to secondary care up to May 2016 compared to the Referrals

trend across this Financial Year and last Financial Year.

Chart A (below) shows numbers of referrals for West Lancashire CCG across all Lancashire providers and Merseyside

providers. Referrals to Fairfield are now included as the Trust has been submitting data for all of 2015/16 so like for like

comparisons can be made.Overall there has been an increase by 278 (2.8%) in all sources of referrals YTD from same

period last year. GP referrals have increased by 0.4%, an increase of 23 when comparing same period 2015/16 to

2016/17. Hospital referrals have reduced by 3.3% (85 referrals) and other referrals have increased by 27.5% (340

referrals). The increase in other referrals is spread across many specialties but with particular increase in midwife

epsiodes, general medicine and orthotics. However, some of these apparent increases in other may be due to a change

in recording from other referral sources/specialty codes.

Overall, the main overperforming specialties are optomometry (140), ophthalmology (109), ENT (101) and audiological

medicine (76).

Overall reductions in referrals have occurred in a number of specialties but particularly in physiotherapy (-117),

cardiology (-48) and breast surgery (-47).

Further analysis is required to understand these shifts in more detail.

Chart A: Referrals 2016/17 Compared to 2015/16 (Including Mersey Trusts)

Our main provider Southport & Ormskirk Trust has seen referrals increase by 1.8% in all sources (114 referrals); GP

referrals have decreased by 95 (-2.3%) compared to same period last year. The overall market share in total referrals

for Southport & Ormskirk Trust has decreased by -0.58% compared to same period last year.

The specialties experiencing increases at S & O are Optometry 157.3% increase (140 refs), Audiological Medicine which

has only been recorded since July 2015 and accounted for a total of 76, ENT 17% increase (67 refs) and Ophthalmology

11.1% increase (66 refs). The specialties experiencing decreases at S & O are Trauma & Orthopaedics -15.5% decrease

(-116 refs), Physiotherapy -12% decrease (-115 refs) and Obstetrics -55.1% decrease (-114 refs). The latter may be due

to a change in recording to Midwife episodes which has seen a similar increase.

Our Second main provider Wrightington, Wigan & Leigh NHS Foundation Trust (WWL) has seen a 0.6% increase in GP

referrals from 2015/16 to 2016/17; Trauma & Orthopaedics has increased by 12% a total of 32 Refs in compared to

corresponding period last year. There have also been extra 19 referrals to Gynaecology (126.7%). Breast Surgery

decreased by -24 refs (24%). Overall market share for WWL total referrals decreased by 0.20% compared to same

period last year.

-

1,000

2,000

3,000

4,000

5,000

6,000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Referrals By Source - Financial YTD Comparison Year on Year GP 2015-16 HOSPITAL 2015-16 OTHER 2015-16

2015-16 Total GP 2016-17 HOSPITAL 2016-17

10 | P a g e

University Hospitals Aintree Trust has seen a decrease in GP Refs -90 (-30.7%) when comparing to same period last year.

This is mostly attributed to Breast Surgery (-31, -31.6% decrease) ENT (-43, service not available in 2016/17) and

Respiratory Medicine (-40, -51.33% decrease). The overall market share in total referrals for Aintree has decreased by -

0.89% compared to same period last year.

St Helens & Knowsley has seen an increase of 31 GP Refs (30.4%) when comparing to same period last year. This is

mainly attributed to Plastic Surgery (increase of 8, 25.8% in period) and ENT (increase of 8, 200% in period). Overall

market share for St Helens & Knowsley total referrals increased by 0.27% compared to same period last year.

There’s an increase in GP referrals to Ramsay, particularly in Trauma & Orthopaedics (+52,23.2%), Gynaecology (+57,

54.3%) and Urology (+20, 35.7%) when comparing to same period last year. Overall market share in Ramsey total

referrals increased by 1.62% compared to same period last year.

There’s also an increase in GP referrals to Fairfield Hospital, particularly in ENT (+47, 123.7%), Trauma & Orthopaedics

(+25, 125%) and Ophthalmology (+21, 350%) when comparing to same period last year. Overall market share in Fairfield

Hospital total referrals increased by 0.89% compared to same period last year.

5. Planned Care: eReferrals Service (previously Choose & Book) The E-Referral Service (e-RS) utilisation data for NHS West Lancashire CCG practices based on Secondary Use Service (SUS) data for May 2016 shows a decrease to 95.06%.

The e-Referral quality premium has been designed to Increase the proportion of GP referrals made by e-referrals. The referral quality premium (QP) is worth £1 per head of patient population which is currently about £112,501. In order for NHS West Lancs CCG to achieve the new 2016/17 QP the CCG will need to either:

Month &

Year %

Apr-14 Apr

May-14 May

Jun-14 Jun

Jul-14 Jul

Aug-14 Aug

Sep-14 52.4% Sep

Oct-14 50.0% Oct

Nov-14 50.4% Nov

Dec-14 48.5% Dec

Jan-15 47.2% Jan

Feb-15 54.4% Feb

Mar-15 58.8% Mar

Apr-15 63.0%

May-15 71.7%

Jun-15 71.2%

Jul-15 77.9%

Aug-15 80.8%

Sep-15 81.7%

Oct-15 83.7%

Nov-15 91.2%

Dec-15 83.5%

Jan-16 94.2%

Feb-16 97.8%

Mar-16 96.6%

Apr-16 99.5%

May-16 95.1%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

%

Month

% of C&B Bookings of GP Referrals Sep 14 -May 162014/15 2015/16 2016/17

11 | P a g e

Meet a level of 80% by March 2017 (March 2017 performance only) and demonstrate a year on year increase in the percentage of referrals made by e-referrals (or achieve 100% e-referrals), or;

March 2017 performance to exceed March 2016 performance by 20 percentage points.

Monthly Activity Return (MAR) data for March 2016 which will be used as the stands at 76%, requiring an increase in e-RS Utilisation of 4% for up to March 2017 to achieve 80% e-RS utilisation. Work to meet the overall aims of improving the efficiency of referral processes for practices and local providers has continued. Input from the Health and Social Care Information Centre (HSCIC) has commenced and they are in the process of compiling reports to identify problem areas that can be addressed to improve e-RS utilisation as reported using Monthly Activity Return (MAR) data which shows a lower utilisation than SUS data. Work to understand SUS and MAR data has been started with the CCG Business Intelligence staff so that reports future will be more meaningful.

6. Planned Care: Acute Contract

All Providers Performance at month 2 against the planned care element of the contract is shown below in table 2a. This shows the planned care element of the contracts is under plan by £90K. While the greatest variance is seen in OPPROC POD (-£81K), the greatest specialty level variance at a single provider is in EL POD 110: Trauma & Orthopaedics at Southport and Ormskirk Hospital NHS Trust (-£91K). Table 2a: Month 2 Planned Care – All Providers

Southport and Ormskirk Hospitals NHS Trust

Performance at month 2 against the planned care element of the contract is shown below in table 2b. This shows the planned care element of the contract is under plan by £207K.The most significant variance is in OPPROC POD. The most significant variances within the EL POD are 110: Trauma and Orthopaedics (-£49K) and 100: General Surgery (-£27K). The greatest specialty variance within a POD is in OPPROC POD 110: Trauma & Orthopaedics (-£91.5K).

Table 2b: Month 2 Planned Care at Southport and Ormskirk Hospitals

All Other Providers Performance at month 2 against the planned care element of the contract is shown below in table 2c. This shows the planned care element of the contract is over plan by £117K. This over performance is primarily seen in DC POD (£31K).

Plan Actual Variance Plan Actual Variance

DC 2,506 2,538 32 £1,780,762 £1,794,982 £14,220

EL 410 373 -37 £1,155,779 £1,090,810 -£64,969

ELXBD 166 71 -95 £37,353 £15,737 -£21,616

OPFA 4,412 4,663 251 £692,198 £724,243 £32,045

OPFUP 10,097 10,616 519 £964,010 £985,021 £21,011

OPPROC 4,173 3,861 -312 £746,557 £665,921 -£80,636

DIAGNOSTIC IMAGING 1,960 1,979 19 £176,126 £186,092 £9,965

Grand Total 23,723 24,101 378 £5,552,785 £5,462,806 -£89,980

Point of DeliveryActivity 2016/17 Cost 2016/17


DC 1,513 1,511 -2 £886,217 £869,263 -£16,954

EL 190 155 -35 £467,912 £384,249 -£83,663

ELXBD 62 20 -42 £13,799 £4,303 -£9,496

OPFA 2,343 2,457 114 £361,955 £371,070 £9,116

OPFUP 6,051 6,268 217 £579,445 £577,189 -£2,256

OPPROC 2,952 2,559 -393 £535,638 £433,510 -£102,128

DIAGNOSTIC IMAGING 1,013 946 67- £81,935 £80,088 -£1,847

Grand Total 14,125 13,916 209- £2,926,900 £2,719,672 -£207,228

Point of DeliveryActivity 2016/17 Cost 2016/17

12 | P a g e

Table 2c: Month 2 Planned Care at All other Providers

Key Risks and Actions Although it is too early in the year to draw any robust conclusions, it should be noted that the level of underperformance has reduced since the end of April. In fact there was a slight increase in planned activity in May. This will be monitored closely in the next few months to enable appropriate actions to be taken as required. The overall underperformance in planned care is mainly driven by significant underperformance at S & O in April, particularly in T & O (outpatient procedures and elective inpatients and day cases).However, there is a significant overperformance at Ramsay in most specialties but in Pain Management (£57k) and orthopaedics (£37k) in particular. Work is on going to understand whether this is due to a shift in activity from S & O to Ramsay.

7. Unplanned Care: Acute Contract

All Providers Performance at month 2 against the unplanned care element of the contract is shown below in table 3a. Overall the unplanned care element of the contract is over plan by £339K. This is caused by significant over performance in NEL POD which is £319K over plan. Please see below for variances for Southport and Ormskirk Hospitals Foundation Trust. Table 3a: Month 2 Unplanned Care at All Providers

Southport and Ormskirk Hospitals NHS Trust


Wrightington, Wigan & Leigh 2,494 2,516 22 £744,480 £696,076 -£48,403

Ramsay Operations (UK) 1,884 2,371 487 £583,066 £743,508 £160,442

Aintree University Hospitals 1,650 1,655 5 £354,175 £328,828 -£25,347

Lancashire Teaching Hospitals 546 622 76 £117,979 £113,535 -£4,444

St Helens and Knowsley Hospitals 668 720 52 £176,763 £188,481 £11,718

Royal Liverpool and Broadgreen Hospitals 1,082 1,123 41 £246,046 £282,295 £36,249

Other Providers 1,273 1,178 -95 £403,377 £390,410 -£12,966

Grand Total 9,598 10,185 587 £2,625,886 £2,743,134 £117,248

ProviderActivity 2016/17 Cost 2016/17


Accident and Emergency 5,063 5,208 145 £598,652 £621,266 £22,613

Non-Elective Short Stay 209 231 22 £156,929 £155,264 -£1,665

Non-Elective 1,374 1,492 118 £2,507,121 £2,825,641 £318,520

Non-Elective Excess Beddays 731 926 195 £160,965 £199,545 £38,579

Non-Elective Non-Emergency 212 292 80 £415,633 £367,905 -£47,729

Non-Elective Non-Emergency Excess Beddays 64 29 -35 £18,027 £10,440 -£7,586

Non-Elective Same Day Emergency Care 114 127 13 £92,507 £111,385 £18,877

Non-Elective Threshold Adjustment 0 0 0 -£1,511 -£3,698 -£2,187

Grand Total 7,767 8,305 538 £3,948,324 £4,287,747 £339,423


13 | P a g e

Performance at month 2 against the unplanned care element of the contract is shown below in table 3b. Overall the unplanned care element of the contract is over plan by £198K. This is largely due to an over performance in NEL 300: General Medicine which is £169K over plan. Table 3b: Month 2 Unplanned Care at Southport and Ormskirk Hospitals

All Other Providers Performance at month 2 against the unplanned care element of the contract is shown below in table 3c. Overall the unplanned care element of the contract is over plan by £142K. The most significant variance is general over-performance at Wrightington, Wigan & Leigh which is £135K over plan.

Table 3c: Month 2 Unplanned Care at All Other Providers

*Includes points-of-delivery as per Tables 3a and 3b

Although it is too early in the year to draw any robust conclusions, it should be noted that the level of over performance

has reduced since the end of April. The month 2 figures at S & O also contain uncoded activity in general medicince non

elective spells which may be contributing to the level of overperformance. This is due to an interim tariff of £3,201 being

applied which is significantly higher than the average tariff for coded activity of £2,190. The reason for such levels of

uncoded activity and the interim costs associated are being rasied with the Trust.

The main overperforming HRGs in general medicine at S & O relate to respiratory conditions.

Unplanned care is also significantly over at WWL. This is mainly due to increases in nonelective activity (£104k). General

medicine is up by £58k and T and O by £47k.Most of the general medicine increase is due to hepatobiliary and

pancreatic and respiratory conditions. The main overperforming HRGS in T and O are due to hip procedures. A & E

attendances are also overperforming by £21k.

8. Prescribing


Accident and Emergency 3,952 3,979 27 £468,910 £474,601 £5,691

Non-Elective Short Stay 141 148 7 £109,281 £103,947 -£5,333

Non-Elective 1,088 1,154 66 £1,903,561 £2,072,457 £168,896

Non-Elective Excess Beddays 582 768 186 £125,690 £164,103 £38,413

Non-Elective Non-Emergency 186 276 90 £346,503 £319,544 -£26,959

Non-Elective Non-Emergency Excess Beddays 34 29 -5 £9,821 £10,440 £619

Non-Elective Same Day Emergency Care 91 102 11 £74,243 £90,753 £16,510

Grand Total 6,074 6,456 382 £3,038,009 £3,235,846 £197,837



Wrightington, Wigan & Leigh 667 905 238 £334,226 £469,655 £135,428

Aintree University Hospitals 283 312 29 £169,964 £213,452 £43,487

Lancashire Teaching Hospitals 218 142 76- £92,542 £73,843 -£18,699

Royal Liverpool and Broadgreen Hospitals 135 165 30 £87,409 £101,445 £14,036

St Helen's & Knowsley Hospitals NHS Trust 113 85 28- £55,758 £54,144 -£1,614

Other Providers 277 240 37- £170,415 £139,363 -£31,052

Grand Total 1,693 1,849 156 £910,315 £1,051,901 £141,586


14 | P a g e

In order to address the West Lancashire CCG Medicines Management duties as defined by the National Prescribing Centre’s Medicines Management Competency Framework, West Lancashire CCG has set up a Medicines Management Committee (MMC). The MMC’s remit encompasses all systems, policies and procedures designed to ensure the safe, secure and cost-effective use of medicines. Below is a summary of prescribing costs. West Lancashire CCG is showing a cost growth of +10.34% in 2016/17. Practices in West Lancashire CCG have the 4th lowest spend per APU of all CCGs across Lancashire as shown in the table below. However, it is too early in the year to make any robust comparisions.

The prescribing position by practice is shown in the table overleaf. The medicines management team are in the process of having discussions with practices about their end of year position.

15 | P a g e

Medicines Management

16 | P a g e

9. Lancashire Care Foundation Trust Contract Activity The contract value for Lancashire Care Foundation Trust (LCFT) mental health services is £9.7m. The LCFT contract is for a range of mental health services such as rehabilitation, community mental health teams, hospital liaison, memory assessment, CAMHS and child psychology and prison in-reach. Below is activity for 2016-17 by Month and Quarter up to M02.

Metric CCG April May Q1 Total Year to Date

Adult Ward Occupied Bed Days WL CCG 318 416 734 734

Adult/PICU Ward Admissions WL CCG 11 12 23 23

Adult/PICU Ward Discharges WL CCG 9 10 19 19

CCTT Teams - Accepted Referrals WL CCG 49 42 91 91

CCTT Teams - Contacts WL CCG 856 851 1707 1707

CMHT Contacts WL CCG 484 425 909 909

CMHT Referrals WL CCG 20 4 24 24

Community Restart Teams - Accepted Referrals WL CCG

1 1 1

CRHT Face to Face Contacts - 18 to 65 WL CCG 129 154 283 283

CRHT Face to Face Contacts - Below 18 WL CCG 2 1 3 3

CRHT Teams - Referrals WL CCG 30 46 76 76

CRHT Telephone Contacts - 18 to 65 WL CCG 159 205 364 364

CRHT Telephone Contacts - Below 18 WL CCG 3 2 5 5

CRHT Telephone Contacts - Over 65 WL CCG

5 5 5

Criminal Justice Liaison - Contacts WL CCG 20 22 42 42

Eating Disorder Service - Contacts WL CCG 12 8 20 20

Eating Disorder Service - Referrals WL CCG 4 7 11 11

EIS: New EIS Patients in Year - VSMR 5378 WL CCG 1

1 1

Hospital Liaison Contacts WL CCG

19 19 19

Hospital Liaison Referrals WL CCG

3 3 3

MAS Teams - Referrals WL CCG 52 27 79 79

Older Adult (Dementia) Ward Occupied Bed Days WL CCG 30 31 61 61

Older Adult (Functional) Inpatient Ward Admissions WL CCG 3 1 4 4

Older Adult (Functional) Inpatient Ward Discharges WL CCG 2

2 2

Older Adult (Functional) Ward Occupied Bed Days WL CCG 86 101 187 187

PICU Ward Occupied Bed Days WL CCG 84 62 146 146

PICU Wards - Transfers In WL CCG 2

2 2

RITT Contacts WL CCG 12 8 20 20

RITT Referrals WL CCG

1 1 1

17 | P a g e

New Format of Report Data previously reported as Older Adult Liaison, is now being reported as Hospital Liaison. The Intermediate Support Team activity for Older Adults (Dementia and Functional) is now being reported under one service line, and is now called the Rapid Intervention and Treatment Team (RITT). The change to RITT has led to extra referrals being within year to date reporting, which is due to this team’s activity also covering Care Home Liaison, which has previously not been reported. 9a Care Programme Approach (CPA) follow- up within 7 days The proportion of eligible patients followed up within 7 days is one of the performance measures on which CCG is monitored by Local Area Team. The Tables below show current West Lancashire performance with a Target of 95%.

9b IAPT – Performance SUMMARY of KEY PERFORMANCE for May

Detailed information is available on request.

Prevalence

West Lancs CCG achieved it’s May 2016 IAPT Access target by 29 patients. Prevalence is assessed based on an agreed 9% of standardised population data. The fact that other CCG’s over-performed their access targets reduces capacity available for West Lancs residents.

Recovery Following discussion at previous CCG Performance Meetings, the service has introduced measures to exclude data for patients with severe presentations as measured by PHQ 9 (20 and above) and GAD 7 (15 and above). This is consistent with approach taken in other IAPT services. West Lancs CCG failed it’s recovery target in May 2016, achieving 45.5%. The recovery target is 50%. The trend is for recovery to continue to improve. Exceptions are Preston and Lancaster. Focussed work is ongoing within these teams to increase access to Silvercloud and to offer multiple interventions (rather than episodic care) to support improved recovery and also reduced waits.

% Successful Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q1 to

date Q2 Q3 Q416/17

NHS West Lancashire CCG 100.00% 100.00% 100.00% 100.00%

Total Figure - 8 CCGs 95.96% 94.92% 95.39% 95.39%

PrevalenceMonthly

TargetApr-16 April May-16 May

Quarterly

TargetQ1

YTD

Entered

Treatment

YTD

Variance

YTD

Prevalenc

e Met (%)

YTD

Variance

(%)

Year End

Cumultive

(Target 15%)

Year

End

Target

NHS BLACKBURN WITH DARWEN CCG 246 224 1.14% 306 1.55% 738 530 530 530 2.69% 2.69% 2.69% 15%

NHS EAST LANCASHIRE CCG 594 544 1.14% 557 1.17% 1782 1101 1101 1101 2.32% 2.32% 2.32% 15%

NHS CHORLEY AND SOUTH RIBBLE CCG 258 313 1.52% 314 1.52% 774 627 627 627 3.04% 3.04% 3.04% 15%

NHS GREATER PRESTON CCG 318 363 1.43% 402 1.58% 954 765 765 765 3.01% 3.01% 3.01% 15%

NHS WEST LANCASHIRE CCG 174 133 0.96% 203 1.46% 522 336 336 336 2.41% 2.41% 2.41% 15%

NHS FYLDE & WYRE CCG 216 217 1.26% 185 1.07% 648 402 402 402 2.33% 2.33% 2.33% 15%

NHS LANCASHIRE NORTH CCG 228 215 1.18% 237 1.30% 684 452 452 452 2.48% 2.48% 2.48% 15%

18 | P a g e

Indicative Recovery 2016/16Completed

Treatment

Moved to

recovery

Not at

CasenessApr-16

Completed

Treatment

Moved

to

recovery

Not at

CasenessMay-16

Cumulative

Completed

Treatment

Cumulative

Moved to

recovery

Cumulative

Not at

Caseness

Year End

Trend

NHS BLACKBURN WITH DARWEN CCG 106 49 4 48.0% 83 40 5 51.3% 189 89 9 49.4%

NHS EAST LANCASHIRE CCG 276 118 30 48.0% 273 130 16 50.6% 549 248 46 49.3%

NHS CHORLEY AND SOUTH RIBBLE CCG 123 64 7 55.2% 91 37 2 41.6% 214 101 9 49.3%

NHS GREATER PRESTON CCG 128 46 10 39.0% 162 62 8 40.3% 290 108 18 39.7%

NHS WEST LANCASHIRE CCG 63 33 2 54.1% 91 40 3 45.5% 154 73 5 49.0%

NHS FYLDE & WYRE CCG 70 36 3 53.7% 55 24 5 48.0% 125 60 8 51.3%

NHS LANCASHIRE NORTH CCG 106 41 7 41.4% 95 38 2 40.9% 201 79 9 41.1%

19 | P a g e

10. Quality and Performance 10a West Lancashire CCG Performance Dashboard

A pr M ay Jun Jul A ug Sep Oct N o v D ec Jan M ar

RAG G G

Actual 95.989% 95.833%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG R G

Actual 90.244% 96.154%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG G G

Actual 100.00% 98.182%

Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00%

RAG R R

Actual 90.909% 80.00%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG R G

Actual 94.118% 100.00%

Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00%

RAG G R

Actual 100.00% 87.50%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG G R

Actual 95.652% 72.727%

Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

RAG

Actual - -

Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

RAG

Actual 100.00% 83.333%

Target

% of pa tie nts re c e iving tre a tme nt for c a nc e r within 6 2 da ys upgra de

the ir priority

West Lancashire CCG

90.476%

% of pa tie nts re c e iving tre a tme nt for c a nc e r within 6 2 da ys from a n

NHS Ca nc e r Sc re e ning Se rvic e

West Lancashire CCG R

90.00% 90.00%

% of pa tie nts re c e iving 1st de finitive tre a tme nt for c a nc e r within 2

months (6 2 da ys)


84.444%

85.00% 85.00%

% of pa tie nts re c e iving subse que nt tre a tme nt for c a nc e r within 3 1

da ys (Ra diothe ra py Tre a tme nts)

West Lancashire CCG G

96.00%

94.00% 94.00%


da ys (Drug Tre a tme nts)


97.059%

98.00% 98.00%


da ys (Surge ry)


87.50%

94.00% 94.00%

% of pa tie nts re c e iving de finitive tre a tme nt within 1 month of a c a nc e r

dia gnosis


98.99%

96.00% 96.00%

% of pa tie nts se e n within 2 we e ks for a n urge nt re fe rra l for bre a st

symptoms


92.537%

93.00% 93.00%

Cancer Waiting Times

% Pa tie nts se e n within two we e ks for a n urge nt GP re fe rra l for

suspe c te d c a nc e r


95.91%

93.00% 93.00%

Preventing People from Dying Prematurely

Me tricRe porting

Le ve l

2016-17

Q1 Q2 Q3 Q4 YT D

F eb

20 | P a g e

RAG R R

Actual 41.38% 70.00%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG G R

Actual 76.47% 74.28%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R

Actual 53.37% 57.60%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R

Actual 67.46% 66.26%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R

Actual 86.49% 86.20%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG R R

Actual 92.01% 91.47%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

91.731%

95.00% 95.00%

Ca te gory A c a lls re sponde d to within 19 minute s West Lancashire CCG R

86.347%

95.00% 95.00%

NORTH WEST

AMBULANCE

SERVICE NHS TRUST

R

66.839%

75.00% 75.00%

Ca te gory A (Re d 2 ) 8 Minute Re sponse Time West Lancashire CCG R

55.47%

75.00% 75.00%

NORTH WEST

AMBULANCE

SERVICE NHS TRUST

R

75.366%

75.00% 75.00%

Ca te gory A Ca lls Re sponse Time (Re d1) West Lancashire CCG R

53.062%

75.00% 75.00%

NORTH WEST

AMBULANCE

SERVICE NHS TRUST

G

Ambulance

RAG

Actual 12.121%

Target

Emergency Re-admissions

Emergency Re - admissions within 30 days of discharge West Lancashire CCG

12.121%

Helping People to Recover from Episodes of Ill Health or Following Injury

21 | P a g e

RAG R R

Actual 3 5

Target 0 0 0 0 0 0 0 0 0 0 0

RAG R G

Actual 0.88 0.00

Target 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

RAG G G

Actual 96.315% 95.934%

Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00%

RAG R R

Actual 1 1

Target 0 0 0 0 0 0 0 0 0 0 0

RAG G G

Actual 0.824% 0.48%

Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%

RAG G G G

YTD 0 0

Target 0 0 0 0 0 0 0 0 0 0 0

RAG G G

YTD 3 6

Target 4 8 11 15 19 22 26 30 34 38 46

Numbe r of C.Diffic ile infe c tions West Lancashire CCG G

6

42 11

HCAI

Numbe r of MRSA Ba c te ra e mia s West Lancashire CCG

0

0 0

Treating and Caring for People in a Safe Environment and Protect them from Avoidable

Harm

% of pa tie nts wa iting 6 we e ks or more for a dia gnostic te st West Lancashire CCG G

0.652%

1.00% 1.00%

Re fe rra l to Tre a tme nt RTT - No of Inc omple te Pa thwa ys Wa iting >5 2

we e ks


2

0 0

Re fe rra l to Tre a tme nt RTT (Inc omple te ) West Lancashire CCG G

96.122%

92.00% 92.00%

Referral to Treatment (RTT) & Diagnostics

Mixe d Se x Ac c ommoda tion - MSA Bre a c h Ra te West Lancashire CCG R

8.00

0.00 0.00

EMSA

Mixe d se x a c c ommoda tion bre a c he s - All P rovide rs West Lancashire CCG R

8

0 0

Ensuring that People Have a Positive Experience of Care

22 | P a g e

RAG R

Actual 92.97%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG R

Actual 87.683%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG R

Actual 88.596%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG

Actual 5,746

Target

RAG

Actual 8,962

Target

RAG

Actual 7,368

Target

RAG

Actual 10,035

Target

RAG

Actual 7,368

Target

RAG

Actual 11,005

Target

RAG G

Actual 0

Target 0 0 0 0 0 0 0 0 0 0 0

RAG G

Actual 0

Target 0 0 0 0 0 0 0 0 0 0 0

RAG R

Actual 1

Target 0 0 0 0 0 0 0 0 0 0 0

SOUTHPORT AND

ORMSKIRK HOSPITAL

NHS TRUST

R

1

0 0

0

0 0

12 Hour Trolle y wa its in A&E WRIGHTINGTON,

WIGAN AND LEIGH

NHS FOUNDATION

TRUST

G

0

0 0

LANCASHIRE

TEACHING

HOSPITALS NHS

FOUNDATION TRUST

G

SOUTHPORT AND

ORMSKIRK HOSPITAL

NHS TRUST 11,005

7,368

A&E Atte nda nc e s: All Type s LANCASHIRE

TEACHING

HOSPITALS NHS

FOUNDATION TRUST

10,035

WRIGHTINGTON,

WIGAN AND LEIGH

NHS FOUNDATION

TRUST

WRIGHTINGTON,

WIGAN AND LEIGH

NHS FOUNDATION

TRUST

7,368

8,962

A&E Atte nda nc e s: Type 1 SOUTHPORT AND

ORMSKIRK HOSPITAL

NHS TRUST 5,746

LANCASHIRE

TEACHING

HOSPITALS NHS

FOUNDATION TRUST

SOUTHPORT AND

ORMSKIRK HOSPITAL

NHS TRUST

R

88.596%

95.00% 95.00%

87.683%

95.00% 95.00%

4 - Hour A&E Wa iting Time Ta rge t (Monthly Aggre ga te for Tota l

Provide r)

WRIGHTINGTON,

WIGAN AND LEIGH

NHS FOUNDATION

TRUST

R

92.97%

95.00% 95.00%

LANCASHIRE

TEACHING

HOSPITALS NHS

FOUNDATION TRUST

R

Accident & Emergency

23 | P a g e

10b Southport & Ormskirk Hospitals NHS Trust Integrated Performance Dashboard

Rolling 2016/17 2016/17 2016/17

INDICATOR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY TREND Q2 Q3 Q4 Q1 YTD TARGET

18 Weeks - Ongoing - % <18 Weeks - Trust 93.4% 93.9% 93.5% 93.4% 93.7% 94.8% 96.0% 95.9% 97.0% 96.7% 97.1% 96.3% 95.8% 93.7% 95.9% 97.1% 95.8% 95.8% 92.0%

A&E - Left Dept Without Being Seen Rate - Trust 1.91% 1.94% 2.35% 1.95% 2.24% 2.29% 2.64% 3.07% 3.71% 3.24% 3.47% 2.31% 2.25% 5.00%

A&E - Time to Initial Assessment - 95th %tile - Trust 10.0 9.0 10.0 10.0 9.0 9.0 12.0 12.0 10.0 11.0 13.0 10.0 11.0 15.0

A&E - Time to Treatment - Median - Trust 45.0 44.0 50.0 48.0 56.0 58.0 56.0 54.0 60.0 66.0 71.0 51.0 47.0 60.0

A&E - Total Time - 95th Percentile - Trust 283.0 239.0 239.0 270.0 373.0 387.0 350.0 422.0 516.0 446.0 459.0 416.0 393.0 240.0

A&E - Total Time in A&E - 4 Hour % - Trust Overall 93.94% 95.95% 95.50% 95.83% 92.42% 91.55% 91.46% 87.53% 83.38% 85.35% 84.62% 88.60% 89.96% 94.58% 90.18% 84.45% 89.28% 89.28% 95.00%

A&E - Total Time in A&E - 4 Hour % - RVY01 89.40% 90.04% 89.10% 90.90% 81.44% 79.03% 78.59% 71.62% 60.20% 55.85% 53.20% 66.69% 70.45% 87.15% 76.41% 56.41% 68.57% 68.57% 95.00%

A&E - Unplanned Re-attendance Rate (within 7 days) - Trust 0.92% 1.03% 0.84% 0.40% 0.74% 1.48% 1.09% 1.20% 0.86% 0.79% 0.71% 0.75% 0.80% 5.00%

ALOS - Elective - Trust 0.33 0.31 0.37 0.31 0.30 0.36 0.31 0.42 0.28 0.32 0.30 0.29 0.34 0.31 0.36 0.30 0.32 0.32 0.37

ALOS - Non-Elective - Trust 4.70 4.88 4.03 4.64 4.77 4.96 4.46 5.26 5.16 5.31 5.25 5.62 4.95 4.56 4.88 5.24 5.27 5.27 4.30

ALOS - Overall - Trust 2.26 2.40 2.10 2.37 2.33 2.49 2.23 2.77 2.49 2.56 2.63 2.73 2.58 2.26 2.50 2.56 2.66 2.66 2.30

Cancelled Operations - % of Total Electives in Month 1.10% 0.78% 0.32% 1.07% 1.17% 2.04% 0.70% 0.86% 0.50% 1.23% 1.57% 0.43% 0.52% 0.97% 1.20% 1.09% 0.47% 0.47% 0.60%

Rolling 2016/17 2016/17 2016/17


Cancer 14 Day - Urgent GP Referral Suspected Cancer 95.4% 96.2% 95.0% 95.0% 94.8% 96.8% 93.9% 98.0% 94.9% 96.2% 97.5% 96.8% 98.1% 96.2% 96.3% 96.8% 0 93.0%

Cancer 31 Day - Decision to Treatment 97.3% 100.0% 100.0% 98.6% 95.8% 97.3% 100.0% 98.0% 98.6% 100.0% 100.0% 100.0% 98.1% 97.9% 99.5% 100.0% 0 96.0%

Cancer 31 Day - Subsequent Treatment - Drug Therapy 100.0% 100.0% NTR 100.0% 100.0% NTR 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0 98.0%

Cancer 31 Day - Subsequent Treatment - Surgery 100.0% 100.0% 90.0% 88.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 83.3% 91.7% 100.0% 95.2% 83.3% 0 94.0%

Cancer 62 Day - GP Referral to Treatment 91.8% 83.3% 87.4% 87.5% 86.5% 89.0% 90.0% 85.7% 79.8% 89.9% 83.7% 93.9% 87.1% 88.0% 84.8% 93.9% 0 85.0%

Cancer 62 Day - Screening Referral to Treatment 100.0% 100.0% 100.0% 0.0% 66.7% 66.7% 100.0% NTR 100.0% NTR NTR 100.0% 37.5% 100.0% 100.0% 100.0% 0 90.0%

Diagnostics waiting time: % >= 6 weeks - All Tests 0.39% 0.37% 0.77% 0.56% 0.42% 0.49% 0.44% 0.54% 0.91% 0.75% 1.02% 0.36% 0.15% 1.00%

DSSA Breaches - Trust 1 4 2 8 5 8 6 11 10 14 19 14 10 15 25 43 24 24 0

2015/16 2016/17 2015/16

2015/16 2016/17 2015/16

24 | P a g e

Rolling 2016/17 2016/17 2016/17


HR - Agency Staff Costs 7.75% 7.90% 7.82% 8.48% 9.66% 8.41% 9.13% 9.59% 8.40% 9.83% 10.68% 10.20% 9.46% 4.00%

HR - Sickness Absence Rate - Trust 4.94% 5.58% 5.12% 4.75% 5.31% 5.96% 5.98% 5.78% 6.14% 4.85% 5.71% 5.08% 4.97% 4.00%

IC - Clostridium Difficile - Trust 3 3 3 2 5 1 3 0 6 4 1 3 5 10 4 11 8 8 36

IC - Number of MRSA - Trust 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0

IC - MRSA Screening - Emergency Admissions - Trust 89.2% 83.4% 82.6% 87.0% 76.8% 82.9% 82.0% 83.0% 85.1% 86.0% 80.0% 81.0% 100.0%

IC - MRSA Screening - Elective Admissions - Trust 98.6% 96.1% 98.3% 96.9% 98.4% 97.4% 97.2% 97.9% 97.3% 98.0% 99.0% 98.0% 100.0%

Mortality - HSMR 12 Month Rolling Total - Trust 101.3 101.0 103.0 103.4 101.9 102.1 100.0 101.9 100.0 90.0

Mortality - HSMR Monthly - Trust 91.0 120.2 95.0 103.3 79.9 86.7 80.8 90.0

Rolling 2016/17 2016/17 2016/17


RM - Never Events - Trust 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 0 0

RM - Patient Falls - by 1,000 bed days 4.4 5.7 4.9 4.1 4.0 4.0 5.2 4.9 4.3 4.1 3.4 4.7 5.4 4.3 4.7 3.9 5.1 5.1

RM - Steis Reportable Incidents - Trust 12 12 4 6 6 5 6 2 6 5 2 10 5 16 13 13 13 13

Stroke/TIA - Stroke 90% Stay on ASU 79.4% 71.4% 85.2% 64.3% 59.1% 79.5% 83.3% 42.9% 55.6% 61.8% 64.0% 43.5% 52.9% 72.6% 55.2% 64.0% 47.5% 47.5% 80.0%

Stroke/TIA - TIA - High Risk Treated within 24Hrs 33.3% 63.6% 80.0% 40.0% 60.0% 60.0% 75.0% 60.0% 62.5% 70.0% 54.5% 28.6% 37.5% 60.0% 66.7% 58.1% 33.3% 33.3% 60.0%

TV - Community Acquired Grade 2 Pressure Sores 23 24 30 30 19 17 24 28 33 19 38 19 41 79 69 90 62 62



TV - Hospital Acquired Pressure Sores - Grade 2-4 - Trust 6 5 6 2 0 6 7 4 8 8 1 4 5 8 17 17 9 9 28

TV - Community Acquired Pressure Sores - Grade 2-4 29 30 34 32 21 21 25 30 36 23 45 29 49 87 76 104 77 77

TV - Hospital Acquired Grade 2 Pressure Sores 4 4 5 2 0 5 6 4 8 7 1 4 5 7 15 16 9 9 18



VTE Prophylaxis Assessment - Trust 96.6% 96.8% 97.4% 95.6% 97.1% 98.1% 97.6% 95.2% 95.2% 95.1% 96.5% 96.1% 98.0% 95.0%

2015/16 2016/17 2015/16

2015/16 2016/17 2015/16

25 | P a g e

10c Areas of Under-Performance for West Lancashire CCG A number of areas of underperformance are reported to end of May 2016 YTD; the detail below is presented by indicator for each of these areas with actions identified as required and on-going, seeking to improve performance. ‘Direction of travel’ of performance against indicator from previous reporting period is provided to demonstrate if performance is deteriorating or improving.

Indicator: Ambulance category call outs – CCG Target: 95% (All Cat A) 75% (Red 1) 75% (Red 2)

Current Performance YTD

86.3% 53.1% 55.5%

Direction of travel

Forecast

Current Issues: All Categories A calls responded to within 19 mins performance has failed to meet the 95% target for our CCG in May 2016. NWAS performance is also under the 95% target at 91.7%. Category A Calls (Red 1) performance has failed to meet the 75% target for our CCG in May 2016. NWAS performance has just met the 75% target at 75.4%. Category A Calls (Red 2) performance has failed to meet the 75% target for our CCG in May 2016. NWAS performance has also failed the 75% target at 66.8%.

Improvement Plans: S&O Trust and NWAS have agreed a new process for Escalation when there are Ambulances queueing at A&E. All Cheshire and Mersey organisations have now signed a Turnover Concordat, aiming at an average of 30 minutes turnover times and zero tolerance for long waits (over 4 hours)

Indicator: Stroke: % Stroke patients spending 90% time on Stroke Unit – S&O

Target: 80%


47.5% Direction of travel

Forecast

Current Issues: The Trust again failed the standard for % Stroke patients on Stroke Unit. Part of the reason is due to the current pressures being experienced in urgent care but the main reason is due to issues around mixed sex accommodation. Staff have struggled due to the sex mix of the 3 bays.

Improvement Plans: At the recent Stroke operational group there was detailed discussion about difficulties in hitting targets despite moving as the RCP suggested to a smaller unit. The Stroke Consultant gave a presentation to CCG quality leads explaining the difficulties associated with the mixed sex issues and bed pressures and gave assurance about Trusts performance when measured against the Sentinel Stroke National Audit Programme (SSNAP) scores.

Indicator: 4hr A+E Waiting Time Target

Target: 95%

Current Performance YTD - Lancashire Teaching

Current Performance YTD – Southport & Ormskirk

Current Performance YTD – WWL

87.68%

88.60%

92.97%

Direction of travel

Forecast

Current Issues: Due to a change in national reporting requirments, the data above is for April 2016, and data for May 2016 is not yet available. The 95% target has been failed by all 3 Providers.

Improvement Plans: The S & O Trust Recovery Plan for A&E has been approved. The CCG has reached financial agreement with the Trust to enable delivery of the plan. The plan will also assist with meeting the ambulance targets.

26 | P a g e

Indicator: Cancer: % patients seen within two weeks for an urgent referral for breast symptoms

Target: 93%



Forecast

Current Issues: Performance for May 2016 increased substantially to 96.15% from 90.24%. YTD, the 93% target just failed to be achieved.

Improvement Plans: As the target was met in 2015/16 and again in May, no actions are currently planned as it is expected that the target will be met in future months.

Indicator: Cancer: % patients receiving 1

st definitive treatment within 62 days

Target: 85%



Forecast

Current Issues: Performance for May 2016 reduced substantially from 95.7% in April to 72.7% in May. YTD, the 93% target just failed to be achieved.

Improvement Plans: RCAs are continuing to be carried out on breaches and learning applied. Processes are in place to receive RCA from all Providers to review and investigate breaches.

Indicator: Cancer: % patients receiving subsequent treatment for cancer within 31 days (Surgery)

Target: 94%



Forecast

Current Issues: Performance dipped to 80% in May 2016 from 90.9% last month. The target of 94% was not met.


Indicator: Cancer: % patients receiving subsequent treatment for cancer within 31 days (Drug Treatments)

Target: 98%



Forecast

Current Issues: Performance improved to 100% in May 2016 from 94.1% last month. The target of 98% was not met.


Indicator: Mixed sex accommodation breaches – S&O

Target: 0


8 YTD Direction of travel

Forecast

Current Issues: The Trust failed the standard for unjustified mixed sex accommodation with another 5 breaches in May 2016, making a total of 8 for 2016/17.

Improvement Plans: They all related to Critical Care and Spinal patients. A joint decision has been made by the Chief Exec and Chief Operating Officer to prioritise this area. The Director of Nursing and Quality is capacity planning to prioritise the movement of patients within the departments. A CCG walk round has been carried out. The issue is on the agenda for the next contract review meeting with the Trust scheduled for 20

th

July 2016.

27 | P a g e

Indicator: RTT No. of incomplete pathways waiting >52 Weeks

Target: 0 Current Performance

1 Direction of travel

Forecast

Current Issues: The CCG has had 1 Breach at Lancashire Teaching Hospitals during May 2016.

Improvement Plans: Chorley & South Ribble and Greater Preston CCG’s are in discussions with LTH around RTT Recovery.

10d West Lancashire CCG Patients Waiting To understand how many patients were still waiting for procedures or outpatient appointments, the numbers of patients waiting for all in-completed pathways for all trusts has been included in the graph below. More detailed reports on RTT waiters are available via Aristotle spotlight reports.

For the Lancashire footprint, in May 2016, there are 6,813 patients in total with an Incomplete Pathway. Of these, 6,536 are Under 18 Weeks and 277 Over 18 Weeks. The table below shows the top 5 highest number of breaches by provider for May 2016 for West Lancashire CCG. 3 of the top 5 have achieved the 92% target. The best performer is Southport and Ormskirk Hospital NHS Trust with 96.14%.

ProviderUnder 18

Weeks

Over 18

WeeksTotal

% In 18

WeeksRAG

SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST: (RVY) 3636 146 3782 96.14%

WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST: (RRF) 553 31 584 94.69%

ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST : (RQ6) 250 22 272 91.91%

LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST: (RXN) 225 20 245 91.84%

AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST: (REM) 335 19 354 94.63%

28 | P a g e

Southport & Ormskirk Possesses 4 specialties failing 92% target; Geriatric Medicine (66.67%), Rheumatology (84.31%), General Medicine (91.53%) & Gastroenterology (91.73%). Wrightington, Wigan and Leigh Has 3 specialties under 92% compliance target; Urology (77.27%), General Surgery (84.62%) & Ophthalmology (90.91%). Royal Liverpool & Broadgreen Possesses 4 specialties failing 92% target; Gastroenterology (80%), General Surgery (80.95%), Trauma & Orthopaedics (90.24%) & Other (91.07%). Lancashire Teaching Hospitals Has 6 specialties under 92% compliance target; Plastic Surgery (57.14%), Neurology (78.26%), Gastroenterology (80%), Ophthalmology (81.25%), Cardiology (83.33%) & Urology (90.91%). Aintree Has 2 specialties under 92% compliance target; Respiratory Medicine (80.95%) & Ophthalmology (91.18%).

29 | P a g e

10e Friends & Family Test

Friends and

Family Test

This month there were3276 - Recommended

responses to the Friends and Family Test included

in the results below. - Not recommended

The following numbers show the proportion of responses

that would recommend or not recommend these

services to a friend or family member.

Q1 Results

*All data shown relates to Southport & Ormskirk NHS Hospitals Trust only,

except for Ambulance (NWAS only), Mental Health (LCFT only) and GP (West

Lancashire GP's only)

A separate report detailing all the response rates and results for the Friends &

Family Test has been provided for the Quality & Safety Committee.

Maternity

Community Health

Mental Health

Staff

GP

Ambulance

May 2016

Inpatient & Daycases

A&E, Walk-in-Centres and

Outpatients

Work

0.9… 0.0…

0.69 0.2

0.9… 0.0…

1 0

1 0

0.9… 0.0…

0.9… 0.0…

0.9 0

00

30 | P a g e

10f Safety Thermometer

On one day each month hospital trusts are required to check to see how many of their patients suffered certain types of harm whilst in their care. This measure is known as the safety thermometer. The safety thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps Trusts to understand where they need to make improvements.

The table below shows the percentage of patients who did not experience any of the four harms in the Trust(s) during the period June 2015 to June 2016.

GP Comments, Concerns & Issues with Healthcare Providers

There were 15 complaints, comments and concerns copied to the CCG from GP’s across West Lancashire in May 2016, 5 of which related to diagnostic test results being sent to the wrong practice. There were a further 8 concerns related to Information Goverance. 1 issue for discharge letter/summary and 1 comment regarding appointment availability. The charts below summarise the trends/themes of comments and complaints over last 12 month period.

Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16Trajectory from

previous month

95.5% 96.4% 94.6% 94.5% 95.4% 95.0% 94.1% 93.5% 93.1% 95.2% 96.3% 95.3% 94.7%

95.4% 94.6% 94.6% 95.9% 97.2% 94.6% 95.5% 95.3% 94.2% 93.7% 93.9% 94.6% 95.6%

95.0% 94.6% 95.2% 94.8% 94.8% 94.6% 94.4% 93.9% 93.8% 91.0% 95.1% 95.3% 96.5%

96.1% 95.5% 94.4% 95.6% 96.1% 95.1% 94.6% 94.6% 95.8% 93.9% 92.8% 94.6% 94.3%

93.9% 94.6% 96.1% 95.5% 95.5% 95.9% 96.4% 95.7% 93.8% 95.4% 94.1% 96.2% 95.7%

95.6% 95.4% 96.2% 95.9% 97.1% 94.9% 95.0% 95.2% 95.9% 96.3% 96.0% 94.5% 93.0%

- Score more than 5% lower than previous month

- Score lower than previous month but within 5%

- Score equal to or higher than previous month

Lancashire Teaching Hospitals NHS Foundation

Trust

St Helens & Knowsley Hospitals NHS Trust

Safety Thermometer - June 2016

Trust

Southport & Ormskirk NHS Hospitals Trust

Wrightington, Wigan & Leigh NHS Foundation

Trust

Aintree University Hospitals NHS Trust

Royal Liverpool & Broadgreen University

Hospitals NHS Trust

31 | P a g e

Themes & trends will continue to be monitored & reported against on a monthly basis, and raised with the Trust through the contract and quality monitoring process as appropriate.

Serious Untoward Incidents Three new StEIS incident was reported in May involving West Lancashire CCG registered patients and one StEIS incident was closed. Four RCA reports were due in May, 1 was received within the 60 days’ time limit, 1 had an extension approved by Southport & Formby CCG and 2 remain outstanding. There have been four nursing home serious incidents reported and two nursing home incidents were closed by the CSU Contracts Team in May. As at 31 May 2016, 66 StEIS incidents remain open involving WL CCG patients, the majority of these are from Southport & Ormskirk Hospitals Trust (54 in total) and the highest reported incidents remain pressure ulcers with 35 incidents currently.

Budget update West Lancashire Clinical Commissioning Group Board Meeting – 26 July 2016

1

WLCCGB 07/16/9


DATE OF BOARD MEETING: 26 July 2016 TITLE OF REPORT: West Lancashire CCG 2016-17 Budget update




No


Yes

The budgets reflect the contractual commitment


Yes

The budgets reflect the agreed prescribing budget


The Governing Body approved the CCG’s financial plan in March 2015. This was based on the best available knowledge of allocation and financial commitments at that time. This report now contains the revised budgets, based on final contractual commitments and revision to financial assumptions. An explanation of the changes is provided. The Governing Body is asked to approve the revised budgets.


No



provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number)



Yes

Risk of not achieving financial balance is budgets are not set realistically.


No




The delivery of the budget plan requires clinical engagement to deliver the commissioning programme, QIPP schemes and to help manage demand in the health economy.


The budget supports the CCG’s commissioning programme which includes a number of schemes that have involved patient and the public from their inception.

REPORT PREPARED BY: REPORT PRESENTED BY:

Paul Jones, Head of finance Paul Kingan, Chief finance officer

West Lancashire CCG 2016/17 Budgets – Update Paper

1. Introduction

West Lancashire CCG’s 2016-17 Financial Plan was presented to the Governing Body on the 22nd

March. This was based on the CCG’s 2016-17 Activity and Finance Plan as submitted to NHS England.

This paper updates the Governing Body on developments and how they have been translated into

operational budgets for 2016/17.

2. Methodology

The planned expenditure figures in the Financial Plan were based on knowledge and assumptions as

they stood at the time on the following parameters:

2015/16 forecast outturn expenditure

Efficiencies generated by the application of the tariff deflator on Provider contracts

Growth in activity volumes

Cost Pressures

QIPP savings

Planned investments (both recurrent and non-recurrent)

In the intervening period between the 22nd March and the Month 3 reporting period the CCG has

refined the figures contained in the Financial Plan. The proposed budgets now reflect:

Actual signed contract values

The finalised Prescribing budget. This includes an additional £265k QIPP requirement, as

discussed at a recent clinical executive committee meeting, which is a necessary measure to

enable the CCG to set a budget that adheres to NHS England’s 2016/17 business rules.

An enhanced understanding of the CCG’s expenditure commitments following the

conclusion of the 2015/16 financial year.

3. Revised 2016/17 Budgets

The table overleaf details the updated budgets and the changes when compared to the Financial

Plan, followed by explanatory notes on selected movements. These budgets have been uploaded

into the CCG’s financial reporting system (ISFE).

2016/17

Financial Plan Revisions

2016/17 Budget

(at Month 3)

Note £000 £000 £000

Revenue Resource Limit a 150,641 334 150,975

Expenditure

Acute services

Acute contracts -NHS (includes Ambulance services) b 74,418 1,750 76,167

Acute contracts - Other providers (non-nhs, incl. VS) 5,103 (454) 4,648

Acute - Other 550 121 671

Acute - Exclusions/Cost per Case 254 30 284

Acute - NCAs 1,271 (5) 1,266

Sub-total Acute services 81,595 1,441 83,036

Mental Health services

MH contracts - NHS c 10,739 306 11,045

MH contracts - Other providers (non-nhs, incl. VS) 107 (1) 106

MH - Other 105 (27) 78

MH - Exclusions/Cost per Case 1,593 (25) 1,568

Sub-total MH services 12,544 253 12,797

Community Health Services

CH Contracts - NHS d 9,911 1,121 11,032

CH contracts - Other providers (non-nhs, incl. VS) 792 34 826

CH - Other 748 536 1,284

CH - Exclusions/Cost per Case 611 24 635

Sub-total Community services 12,062 1,714 13,776

Continuing Care Services e 7,260 1,049 8,309

Local Authority / Joint Services 1,038 (16) 1,022

Free Nursing Care 975 (56) 919

Sub-total Continuing Care services 9,273 978 10,251

Primary Care services

Prescribing 19,126 216 19,342

Community Based Services 882 22 904

Out of Hours/Urgent Care f 2,949 (1,712) 1,237

Sub-total Primary Care services 22,957 (1,473) 21,484

Other Programme services

GP IT Costs 519 66 585

NHS Property Services 1,017 (158) 859

Voluntary Sector Grants/Services 14 (0) 14

Social Care 2,442 - 2,442

Other CCG reserves g 1,161 (2,382) (1,221)

Other Programme Services 958 (113) 845

1% Non Recurrent Reserve 1,468 3 1,471

Sub-total Other Programme services 7,579 (2,583) 4,996

Total - Commissioning services 146,010 330 146,340

Running Costs 2,370 - 2,370

Contingency 754 1 755

Total Application of Funds 149,134 331 149,465

Surplus/(Deficit) 1,507 3 1,510

Notes

a. Revenue Resource Limit – The overall resources available to the CCG have increased by £334k

since the Financial Plan was issued. The CCG’s opening allocation was adjusted to take into

account transfers of services previously deemed to be specialist. Additionally the CCG has

received an allocation of £60k relating to Eating Disorders.

b. Acute Contracts (NHS Providers) – The figures in the financial plan have been superseded by

actual contract values. The increase this figure is predominantly due to 2 factors:

a. Activity relating to the walk in centre on the Ormskirk Hospital site (annual value

approximately £1.7m) was previously classed under ‘Urgent Care’ when charged by the

West Lancashire Health Partnership. Now the Partnership has been disbanded it has

been incorporated into the Southport and Ormskirk Hospitals NHS Trust contract and is

classed within Acute Services.

b. An element of planned QIPP savings that had been assigned to Acute Services within the

initial financial plan have not yet been transferred out of Reserves. These budgets will be

transferred out of Reserves when the CCG has greater certainty of the impact of the

schemes on specific provider contracts.

Partially offsetting the above is a reassessment of the element of the Southport and Ormskirk

NHS Trust contract relating to Community Services.

c. Mental Health Contracts (NHS) – The CCG has incorporated several discrete investments into

the 2016/17 budget.

d. Community Health Contracts (NHS) – This increase is the opposite effect of the reassessment of

the element of the Southport and Ormskirk NHS Trust contract relating to Community Services

mentioned in note b.

e. Continuing Care Services – 2015/16 outturn expenditure was higher than the levels included

within the initial financial plan and accordingly the revised budget is set at a higher level.

f. Out of Hours/Urgent Care - This decrease is the opposite effect of the reclassification of the

Ormskirk walk in centre activity mentioned in note b.

g. Other Reserves – Included within this figure are negative budgets (and associated planned

savings) relating to QIPP schemes that have not yet been applied to individual operational

budget lines. Examples of such schemes are Outpatient attendance reductions and the redesign

of MSK pathways. These budgets will be transferred out of Reserves when the CCG has greater

certainty of the impact of the schemes on specific provider contracts.

4. Conclusion

The Governing Body are requested to approve the revised budgets as detailed in this paper.

Paul Jones

Head of Finance

15th July 2016

Annual public health report West Lancashire Clinical Commissioning Group Board Meeting – 26 July 2016

1

WLCCGB 07/16/10


DATE OF BOARD MEETING: 26 July 2016 TITLE OF REPORT: Securing our Health and Wellbeing – Report of the Director of Public Health and Wellbeing

BRIEFING POINTS: The report describes what determines our health and wellbeing and made recommendations to protect and improve it. It draws attention on three main issues – we have been adding years to our lives but not necessarily life to our years; addressing health inequalities needs action across the social gradient within our county and not just in the most deprived communities; and that protecting and promoting good health is not just a social issue but also crucial for our local and national economy. It is common knowledge that the financial resources within the public sector, both nationally and within our county are not going to increase to meet the needs and demands of our changing demography. Having the focus on financial savings alone can distract organisations from improving health and wellbeing. Therefore, we need to relentlessly pursue the ‘Triple Aim’ of improving outcomes, enhancing quality of care and reducing costs at the heart of everything we do. In order to pursue the ‘Triple Aim’ in our county, we need a strong and longer term political will to radically upgrade our efforts on prevention; we need fully engaged individuals, families, communities and businesses in improving wellbeing; and a workforce that embraces innovation and puts people and the places they live at the centre of everything they do. This report focusses on key actions we need to take on these areas.


A. Commissioning Board’s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient

experience) – please outline impact Yes



4. Delivering Financial Balance – please outline impact Yes 5. Development of the commissioning group as a commissioning

organisation – please outline impact

B. Governance – please outline impact 1. Does this report:


• have any legal implications

Annual public health report West Lancashire Clinical Commissioning Group Board Meeting – 26 July 2016

2

• promote effective governance practice 2. Additional resource implications

(either financial or staffing resources)

3. Health Inequalities Yes 4. Human Rights, Equality and Diversity Requirements 5. Clinical Engagement 6. Patient and Public Engagement REPORT PRESENTED BY: Sakthi Karunanithi, Director of public health and wellbeing

www.lancashire.gov.uk

Securing our Health and WellbeingReport of the Director of Public Health and Wellbeing 2016

comm

s:4625

3

Report of the D

irector of Public H

ealth and Wellbeing - 2016

ContentsPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1 About Lancashire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2 The state of our health and wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.1 Life Expectancy and Healthy Life Expectancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.2 Social, Economic, Environmental Determinants (SEEDs) of Health and Wellbeing . . . . . . . . 9 2.3 Analysis of inequalities within Lancashire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.4 Economy, Ill Health, Disability and State Pension Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.5 Inequalities across the social gradient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

3 Healthier Lifestyles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.1 Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.2 Physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.3 Overweight and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3.4 Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4 Economic case for prevention and early intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

5 Opportunities for improving quality of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 5.1 Analysis of resources utilised in managing complex patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

6 The funding and efficiency gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

7 Strategic Opportunities in Lancashire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

8 Enabling innovation through our workforce and digital technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 8.1 A 21st Century workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 8.2 The 21st Century Public Servant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 8.3 Harnessing the power of digital technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

9 Key actions to secure our health and wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

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16 Preface

It is a well-known fact that Lancashire is the birthplace of the industrial revolution that began in the 18th Century. Our ancestors include some of the most hardworking and innovative people in the world. We have a rich and diverse heritage, culture, social capital and assets on which we have built our economy and health.

The responsibilities for protecting and improving the public’s health were transferred back to Lancashire County Council in 2013. This means the public health functions have come home to the local government, since they left in 1974. Local government has an opportunity to embed public health objectives in everything it does – to address not just ill health prevention and influence the NHS but also promote what determines good health and wellbeing – education, skills, jobs, homes, healthy environments, transport, to name a few. We have already seen some success stories. For example, all the play areas in Lancashire have become smoke free in 2016 and there are many similar exemplars of good practice.

At the same time, there are new challenges. Our county is ageing and the burden of disease is on the rise. The economic downturn at the beginning of this century, the political choices being made by the UK government in allocating the scarce public resources

to address the structural deficit in our economy, and the impact this could have on our lives, and on the sustainability of public services including the NHS is a key concern.

Traditionally, the Directors of Public Health report progress on the recommendations made in their previous reports. As this is my first report covering 2013 – 2015, I have described what determines our health and wellbeing and made recommendations to protect and improve it. I hope to draw your attention on three main issues – we have been adding years to our lives but not necessarily life to our years; addressing health inequalities needs action across the social gradient within our county and not just in the most deprived communities; and that protecting and promoting good health is not just a social issue but also crucial for our local and national economy.

It is common knowledge that the financial resources within the public

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sector, both nationally and within our county are not going to increase to meet the needs and demands of our changing demography. Having the focus on financial savings alone can distract organisations from improving health and wellbeing. Therefore, we need to relentlessly pursue the ‘Triple Aim’ of improving outcomes, enhancing quality of care and reducing costs at the heart of everything we do.

In order to pursue the ‘Triple Aim’ in our county, we need a strong and longer term political will to radically upgrade our efforts on prevention; we need fully engaged individuals, families, communities and businesses in improving wellbeing; and a workforce that embraces innovation and puts people and the places they live at the centre of everything they do. This report focusses on key actions we need to take on these areas.

The last County Medical Officer of Health Dr. Charles Henry Townsend Wade said in his annual report in 1973 “…my grateful thanks to all the staff… who

have continued to co-operate in the maintenance and advancement of the various services, whilst undertaking much work involved in the reorganisation”. I’d like to echo his words and add that I am proud and privileged to be working with so many motivated and inspiring individuals across the county – politicians and professionals across various sectors alike. My vision is to develop Lancashire into a safer, fairer and healthier place for our residents. I invite your feedback, debate, and ideas to shape this further and make the vision into a reality for the current and future generations. Together, let us make Lancashire the birth place for a wellbeing revolution in the 21st Century.

Yours sincerely,

Dr . Sakthi Karunanithi MBBS MD MPH FFPHDirector of Public Health and Wellbeing

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Lancashire has an estimated population of 1.18 million spread over 2,900 km2. The average population density (people per km2) is 408, compared to the North West average of 506 and an England and Wales average of 3801.

The population is projected to increase 5.8% by 2037, with the number expected to reach 1.24 million. The estimated increases are lower than the average for the North West (7.9%) as a whole, and well below the expected increase for England of 16.2%.

At the district level, Hyndburn and Burnley are actually predicted to see small population decreases between 2012 and 2037, whilst Rossendale and Chorley are the only Lancashire authorities with projected increases in excess of 10%.

Analysis by age reveals that most of the age-groups between 0 and 64 years are predicted to decrease between 2012 and 2037. A substantial increase of over 50% is predicted in the over 65 age group. The number of people aged 90 years and older is projected to increase from

around 10,000 in 2012 to around 32,000 in 20372.

2011 census showed that the largest ethnic group is white (90%). The black and minority ethnic group (BME) makes up 8% of the population, the majority of this group were Asian/Asian British. Numerically, there were over 90,000 black minority ethnic people in the county. Three-quarters of the BME population reside in Preston, Pendle, Burnley and Hyndburn. Across England and Wales, the white population accounted for 86% and BME accounted for 14%.

There are wide variations in levels of income, wealth and health across the county. In more rural areas social exclusion exists side-by-side with affluence and a high quality of life. Several districts have small pockets of deprivation, but there are also larger areas of deprivation, particularly in east Lancashire, Morecambe, Skelmersdale and parts of Preston.

Further details of the demography and population projections can be accessed by clicking on Lancashire Insight - www.lancashire.gov.uk/ lancashire-insight.aspx

Lancashire county has 12 district councils and neighbours the two unitary authorities of Blackpool and Blackburn with Darwen. There are six NHS clinical commissioning groups (CCGs) in the council area with one in each of the unitary councils. Lancashire is also served by five key NHS Trusts, over 250 GP practices and a similar number of pharmacies and a wide range of social care providers. A single fire and rescue service, constabulary and police and crime commissioner cover the whole of Lancashire. Key strategic partnerships in the county council area include a Health and Wellbeing board, a Children and Young People Trust Board, a Safeguarding Adults Board, a Safeguarding Children Board, and a Lancashire Enterprise Partnership. There are three main university campuses in the county and specialist agriculture and maritime college facilities.

1 About Lancashire

1 ONS, Mid-2014 Population Estimates2 ONS, 2012-based Sub-National Population Projections

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2 The state of our health and wellbeingOur health and wellbeing is determined not only by the quality of health and care services and lifestyle factors but also by a range of good health promoting factors including the conditions in which we are born, live and work – which are

referred to as the socioeconomic and environmental determinants (SEEDs) or root causes of health. An illustration of the determinants of health by Dahlgren and Whitehead (1992) is provided below. Therefore, it is all these determinants

that we need to act on to improve our health and wellbeing. Many of these are influenced by local and national government policies and programmes and not just by the NHS.

An analysis of key measures of health and wellbeing and its determinants are presented in this report.

Age, sex and hereditary factors

General socioeconomic, cultural and environmental conditions

Individual lifestyle factors

Social and community networks

Living and working conditions unemploymentwork environment

Housing

Health care services

Water and sanitation

education

Agriculture and food

production

The Determinants of Health (1992) Dahlgren and Whitehead

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2 .1 Life Expectancy and Healthy Life Expectancy

Life Expectancy (LE) and Healthy Life Expectancy (HLE) are well known global measures of health and wellbeing. The slope index of inequality in life expectancy and healthy life expectancy is a measure of variation between most deprived and least deprived areas.

The table below shows the female and male LE and HLE in Lancashire.

In summary, the life expectancy at birth for both females and males have been increasing over the years. However, there is a gap of 7.1 and 10.2 years between our least and most deprived areas for females and males respectively.

The gap between the female LE and the national average has also widened. None of the districts are significantly better than the national average. South Ribble, Ribble Valley, West Lancashire, and Fylde are similar to the national average and the rest are significantly worse than national average.

Male LE in Fylde, West Lancashire, and Chorley is similar to the national average. While South Ribble and Ribble Valley have better male LE than the national average, the rest of the districts have significantly worse male LE than the national average.

The average number of years a female child can expect to live in good health, otherwise called healthy life expectancy,

is 62.4 years, meaning they will spend 19.7 years in not so good health.The average number of years a male child can expect to live in good health, otherwise called healthy life expectancy, is 61.3 years, meaning they will spend 17.2 years in not so good health. HLE has been decreasing since 2009. It is significantly worse than England average.

Female MaleLife expectancy at birth in years (Lancashire) 82.1 78.5Life expectancy at birth (England) 83.2 79.5Gap between most and least deprived MSOAs in Lancashire

7.1 10.2

Healthy life expectancy at birth (HLE) in Lancashire 62.4 61.3Healthy life expectancy at birth in England 63.9 63.3

Gap in HLE between most and least deprived MSOAs in Lancashire

15.6 15.8

We have been adding

years to our lives but

not necessarily life to

our years . Healthy life

expectancy in males

has decreased since

2009 . If not addressed,

this is likely to affect

the economy and

productivity of our

workforce .

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2 .2 Social, Economic, Environmental Determinants (SEEDs) of Health and Wellbeing

An independent review, led by Sir Michael Marmot examined the most effective evidence-based strategies for reducing health inequalities in England. The final report, ‘Fair Society Healthy Lives’, was published in February 2010, and concluded that reducing health inequalities would require action on six policy objectives:• Give every child the best start in life. • Enable all children, young people and

adults to maximise their capabilities and have control over their lives.

• Create fair employment and good work for all.

• Ensure healthy standard of living for all.

• Create and develop healthy and sustainable places and communities.

• Strengthen the role and impact of ill-health prevention.

A framework of indicators, called Marmot Indicators, are published regularly for Local Authorities in England. Analysis of

data published in December 20153 has identified that Lancashire is significantly better than the national average in the following areas:• Good level of development at

age 5 (%)• Good level of development at age

5 with free school meal status (%)• Long term claimants of Jobseeker’s

Allowance (rate per 1,000 population).

The analysis also identified that Lancashire is significantly worse than the national average in the following areas:• Life expectancy and healthy life

expectancy for females and males• GCSE achieved 5A*-C including

English & Maths with free school meal status (%)

• Fuel poverty for high fuel cost households (%).

It should be noted there is a significant variation between the districts within Lancashire. Any action to address the SEEDS of wellbeing need to focus on the areas that need the most support as well as improving them across the whole of Lancashire.

Analysis of causes of excess deaths(The Segment Tool) has been developed by Public Health England (PHE) to provide information on the causes of death that are driving inequalities in life expectancy at local area level. Targeting the causes of death which contribute most to the life expectancy gap should have the biggest impact on reducing inequalities. The following chart provides further information on the causes of death that are driving inequalities in life expectancy at Lancashire level. The tool also allows analysis at a district level.4

3 https://neighbourhood.statistics.gov.uk/HTMLDocs/nessgeography/superoutputareasexplained/output-areas-explained.htm 4 https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015

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The chart shows that circulatory diseases (includes coronary heart disease and stroke), cancer, respiratory and digestive diseases (includes alcohol-related conditions such as chronic liver disease and cirrhosis) are the major reasons for the gap in life expectancy between Lancashire and England. Of particular concern is the difference in gap caused by significantly higher proportion of external causes for men (include deaths from injury, poisoning and suicide).

Chart showing the breakdown of the life expectancy gap between Lancashire as a whole and England as a whole, by broad cause of death, 2010-2012

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%Male Female

Circulatory 36.2%

Circulatory 23.4%

Cancer 13%

Cancer 15.8%

Digestive 11.4%

Digestive 12.4%

External causes 4.9%External causes 21.5%

Mental and behavioural 3.6%

Other 5.1% <28 days 5%

Respiratory 23%

Respiratory 20.1%

Other 2.9%Mental and behavioural 1.7%

<28 days 0%

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The Table below shows further breakdown of the life expectancy gap between Lancashire as a whole and England as a whole, by broad cause of death, 2010-2012 .

This means there were at least 2420 excess deaths in Lancashire between 2010 and 2012 compared to England average.

Male Female

Broad cause of death

Number of deaths in local authority

Number of excess deaths in local authority

Contribution to the gap (%)

Number of deaths in local authority

Number of excess deaths in local authority

Contribution to the gap (%)

Circulatory 5,044 364 23.4 5,444 637 36.2Cancer 5,183 211 15.8 4,533 80 13.0Respiratory 2,492 334 20.1 2,819 385 23.0Digestive 918 134 12.4 985 131 11.4

External causes 829 128 21.5 466 17 4.9

Mental and behavioural 880 23 1.7 1,875 74 3.6

Other 1,430 -69 5.1 2,101 -40 2.9

Deaths under 28 days 68 -2 .. 65 12 5.0

Total 16,844 1,124 100 18,289 1,296 100

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2 .3 Analysis of inequalities within Lancashire5

Further local analysis of the inequalities within Lancashire is aimed to target specific actions in the areas causing the most inequalities. The table below describes the ten worst health inequalities in Lancashire.

The ten worst inequalities in health outcomes1 Diabetes Those in the most deprived areas are over seven times as likely to die prematurely from diabetes as those

in the least deprived areas.2 Respiratory

diseaseThose in the most deprived areas are over four and a half times as likely to die prematurely from chronic obstructive pulmonary disease as those in the least deprived areas.

3 Digestive disease Those in the most deprived areas are over three times as likely to die prematurely from chronic liver disease as those in the least deprived areas.

4 Mental health problems

Those in the most deprived areas are three times as likely to suffer from extreme anxiety and depression as those in the least deprived areas.

5 Lung cancer Those in the most deprived areas are over two and a half times as likely to die prematurely from lung cancer as those in the least deprived areas.

6 Circulatory disease

Those in the most deprived areas are over two and a half times as likely to die prematurely from coronary heart disease, and over twice as likely to die prematurely from stroke as those in the least deprived areas.

7 Accidents Those in the most deprived areas are over twice as likely to die prematurely as a result of an accident as those in the least deprived areas.

8 Quality of life Those in the most deprived areas are over twice as likely to experience extreme pain and discomfort and over one and a half times as likely to have problems with mobility, self-care and performing usual activities as those in the least deprived areas.

9 Unplanned hospital admissions

Those in the most deprived areas are over one and a half times as likely to be admitted to hospital in an emergency as those in the least deprived areas Those in the most deprived areas are over one and a half times as likely to be admitted to hospital in an emergency as those in the least deprived areas.

10 Narrow the gap in infant mortality

In the most deprived areas, babies up to one year old are over one and a half times as likely to die as those in the least deprived areas.

5 Based on new health inequalities analysis JSNA 2014. http://www3.lancashire.gov.uk/corporate/web/?siteid=6117&pageid=35405&e=e

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2 .4 Economy, Ill Health, Disability and State Pension Age

It is estimated that more than 130 million days are still being lost to sickness absence every year in Great Britain and working-age ill health costs the national economy £100 billion a year6. This is greater than the annual budget for the NHS in 2013/14 and comparable to the entire GDP of Portugal. The costs to the taxpayer – benefit costs, additional health costs and forgone taxes – are estimated to be over £60 billion.

It is estimated that the state pension age for children born in 2015 will be 68 years. It is therefore important to have as much a healthy and disability free life expectancy as possible during working age and before reaching the state pension age. Using raw data available at middle super output area (MSOA) level, it is estimated that a disability free life expectancy of over 68 years can be achieved in only 18 out of 154 MSOAs for females, and in 12 out of 154 MSOAs for males. This is an important

consideration for having a healthy and productive workforce in the future. We need to act now to create the conditions to have healthy working life for our population, particularly for our children.

2 .5 Inequalities across the social gradient

Another important consideration is that these inequalities are not just present within the most deprived and the rest of Lancashire. There is a gradient across the county based on the indices of deprivation. As an illustration, the bar chart shows the gradient female healthy life expectancy across the 154 MSOAs in Lancashire. Hence, improving the outcomes only in the most deprived areas of Lancashire will not be enough to improve the outcomes across the county. We need a response proportionate to the need in each of these geographical areas. In other words, we need proportionate universalism as described in the Fairer Society, Fairer Lives report by Sir Michael Marmot.

These inequalities are

not just between the

most deprived areas

and the rest . In fact they

exist across our social

gradient . We need to

up our game across all

sections of our society . 6 https://www.gov.uk/government/news/a-million-workers-off-sick-for-more-than-a-month

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Distribution of Female Healthy Life Expectancy across LancashireS

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75.0

70.0

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45.0

State pension age - 68 years

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There is a strong commitment to tackle health inequalities in Lancashire. This was demonstrated by the Joint Strategic Needs Assessment of Health Inequalities conducted in 2009 and then repeated in 2014. Analysis of change in the gap show that the gaps in early deaths from diabetes has widened between 2009 and 2012 and the gap in some of the important causes of health inequalities such as income, fuel poverty and drinking alcohol at levels hazardous to health have also widened over the last three years. On the other hand, the gaps in anxiety and depression and early deaths from heart disease and stroke had narrowed; with rates in the most deprived parts of the population improving faster than the least deprived. This shows that it is possible to narrow the health gap with concerted co-ordinated efforts across partner organisations.

In addition, The Lancashire Fairness Commission was set up to provide an independent perspective on inequality in Lancashire and to make recommendations to increase fairness to Lancashire County Council and its partners. The commission reported in March 2015 and its recommendations can be found at http://www.lancashire.gov.uk/media/584910/4000-Fairer-Lancashire-Fairer-Lives.pdf

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16 3 Healthier LifestylesIt is estimated that around 40% of all deaths in England are related to lifestyles. The NHS spends more than £11bn a year on treating illnesses caused by the effects of diet, inactivity, smoking and drinking alcohol.

Key facts about lifestyles in Lancashire7

Estimates suggest that in England, physical inactivity causes

3 .1 Tobacco 3 .2 Physical activity

7 Various sources, including www.lancahire.gov.uk/JSNA

• Cost of smoking to society in Lancashire is £291.7 million each year, including £50 million NHS care

• A smoker of 20 cigarettes a day spends £2,800 a year, family where both parents smoke spend £5,600 a year

• Two-thirds of smokers (63%) want to quit and welcome support to do so.

Tobacco smoking

kills 1,673 adults aged 35 years and over in Lancashire

each year

19.8%

15.7%

11%

18.8%

11.4%

8%

vs

vs

vs

Adults

Pregnant women

Young people

Smoking rates remain higher in Lancashire than nationally:

Inactivity, described by the DH as a “silent

killer,” directly costs the NHS across the

UK an estimated

£1.06 billion

• Six districts in Lancashire are significantly worse than the national average in terms of children’s activity levels (England average 55.13%)

• In Lancashire, at a county level, the level of inactivity is 30.41% in adults.

• This amounts to 284 premature deaths per annum at a cost of £19,937,814.

• This percentage of inactivity in adults is significantly higher than the national average for England.

10% 13% 17%18%of heart disease

of type 2 diabetes

of all mortality

of breast cancer

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• In Lancashire, the percentage of overweight and obese adults is higher than the national average by 0.9% (Lancashire, 64.7% compared to England 63.8%).

• Similarly, the percentage of overweight and obese children in reception (aged 4-5 years) is higher than the national average by 1.3% (Lancashire, 23.5% compared to England 22.2%).

Obesity is known to be related to social disadvantage.

3 .3 Overweight and Obesity 3 .4 AlcoholAlcohol

misuse costs

£21 billion per year in

England (Lancashire £495m).

Each year, an estimated

£5.1 billion is spent on obesity

related health problems

7.8%24%

21.3%4%

of Lancashire population are estimated to be high risk drinkers

are estimated to be binge drinking

have increasing risk due to alcohol misuseare dependent

...compared to 21% of men and 17% of women with a degree or equivalent.

30% 21%33% 17%Nationally, around 30% of men and 33% of women with no qualifications are obese...

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16 4 Economic case for prevention and early intervention

The National Institute for Health and Care Excellence (NICE) has examined the costs of ill health and advices that public health activities do save money by preventing premature death and reducing preventable diseases can boost the economy.

CIPFA estimates that £1 spent on prevention leads to savings of £5-6 to the public purse. It argues that this kind of “public pound multiplier” is due to the relatively inexpensive interventions that can mitigate the spiralling costs of acute care down the line. If this could be replicated throughout the NHS, the health service would eventually see a reduction in financial pressure.

Another study done by the Early Intervention Foundation shows that picking up the pieces from damaging social problems affecting young people such as mental health problems, going

into care, unemployment and youth crime costs the Government almost £17 billion a year8. Their analysis finds that almost a third of this bill came from the annual £5 billion cost of looking after children in care. An estimated further £4 billion a year is spent on benefits for 18-24 year-olds not in education, employment or training (NEET) with another £900 million spent helping young people suffering from mental health issues or battling drug and alcohol problems.

8 http://www.eif.org.uk/publication/spending-on-late-intervention-how-we-can-do-better-for-less/

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5 Opportunities for improving quality of careThe variation in quality of care across the NHS and the tools to address them have been published by the NHS Right Care programme. Together with the New Care Models, they are aimed to support the vision set out in the Five Year Forward View9 with its focus on the transformation of healthcare services to drive improvements in quality and efficiency.

The table provides a list of common areas of improvement across a range of disease pathways in Lancashire. The data packs for individual CCGs in Lancashire can be accessed here: https://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/nth-2016/#lan

Disease pathway Common themes for improvement across LancashireCancer (Breast, Colorectal and Lung)

Breast screening, Bowel Cancer screening, early diagnosis and starting definitive treatment within 2 months.

Diabetes Control of blood pressure and cholesterolRetinal screening

Common mental health conditions

Improving access to psychological therapy completion and demonstrating reliable improvement

Heart disease Control of hypertension and high cholesterolStroke Treatment of Transient Ischaemic Attack within 24 hours

Patients with stroke spending 90% of the stay in a stroke unitEmergency readmissions within 28 days of discharge

COPD Improving the identification of people with COPD on GP registersMeasuring FEV1 to assess COPD

Asthma Emergency admissions for children and young people (0-18)

Musculoskeletal Management of osteoporosisEQ5D health gain for people undergoing hip and knee replacementEmergency readmissions within 28 days of discharge following hip replacement

Trauma Falls in elderly, emergency readmissions within 28 days of discharge following hip fracture

Renal Percentage of people with chronic kidney disease on home dialysisPercentage of people with renal replacement therapy who have renal transplant

Maternity and early years

Many areas have worse outcomes e.g. under 18 pregnancy, smoking during pregnancy, breast feeding at 6-8 weeks, childhood obesity at reception age, AE attendances for under 5s

9 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

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5 .1 Analysis of resources utilised in managing complex patients

Complex patients are individuals with multiple comorbidities that are likely to utilise most resources across programmes of care and the urgent care system. Understanding them can support local discussions in managing this cohort of the population via integrated care planning and supported self-management arrangements.

Nationally, it is estimated that 2% of patients comprise 15% of spend on inpatient admissions in 2013/14. Nationally the most common conditions of admissions for complex patients are circulation; cancer; and gastro-intestinal problems. Whilst this analysis only focuses on secondary care due to availability of data, it is expected that these patients are fairly representative of the type of complex patients who will require the most treatment across the health and care system. It is not possible to include analysis on mental health patients as they are not captured fully in these datasets.

Other key facts about the complex patients include:• The average complex patient has 6

admissions per year for three different conditions (based on programme budget categories).

• 59% of these complex patients are aged 65 or over; 37% of these complex patients are aged 75 or over

• 13% of these complex patients are aged 85 or over; 92% of the complex patients also had an outpatient attendance during the year. Those patients had 13 attendances a year on average.

• 81% of the complex patients also had an A&E attendance during the year. Those patients had 4 attendances a year on average.

• The proportion of CCG spend on the 2% of their most complex patients is provided in the table below:

CCGNumber of patients

Proportion of CCG spend on their 2% most complex patients

CCG Spend in £‘000

Lancashire North 498 16.5% 10,299Fylde and Wyre 522 15.6% 10,233Greater Preston 689 16.4% 13,444Chorley and South Ribble 589 16.5% 12,167East Lancashire 1,249 16.8% 25,775

West Lancashire 393 16.4% 7,635

Total 3,940 79,553

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6 The funding and efficiency gapIt is estimated that there will be a gap between patient needs and NHS resources of nearly £30 billion a year by 2020/21. In Lancashire, there is an estimated funding gap in excess of £805 million between NHS, adult social care and public health budgets. This gap means that we cannot continue to deliver the services as they are organised and configured. We need to transform the way in which we involve individuals and local communities, address key lifestyle and behaviour change that is required as well as join up services with the needs of individuals and communities at the centre.

The NHS Five Year Forward View focusses on preventing ill health, redesigning more productive services, harnessing innovation and technology, transparency in understanding the spending patterns and maximising the value of the NHS budget as the main ways of closing the funding gap.

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In spite of the challenges in outcomes, quality and costs, there are positive developments happening across Lancashire to address these challenges. For example:

7 Strategic Opportunities in Lancashire

The NHS Five Year Forward View and the Sustainability and Transformation planning guidance has put prevention, a place based approach, and integration of health and social care at the centre. This is already emerging in the two Vanguard programmes (Lancashire North and Fylde and Wyre CCG areas) and similar programmes in other local health care economies.

Local Authorities and the wider public sector agencies are working more closely together. The formation of a Combined Authority will enhance the momentum in improving transport, housing and economic regeneration opportunities. This is a significant development towards reducing health inequalities.

Lancashire Constabulary, Office of the Police and Crime Commissioner, Lancashire Fire and Rescue Service, and the Lancashire schools forum have prioritised prevention and early intervention.

There is an enthusiastic VCFS sector and various new business models to mobilise individuals and communities for collective action on health and wellbeing are already emerging e.g. Lancashire time credits programme.

Lancashire County Council has put improving health and life chances of its residents at the heart of its evolving corporate strategy

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8 Enabling innovation through our workforce and digital technology

10 http://www.birmingham.ac.uk/Documents/college-social-sciences/public-service-academy/21-century-report-28-10-14.pdf

8 .2 The 21st Century Public Servant

1 is a municipal entrepreneur, undertaking a wide range of roles 2 engages with citizens in a way that expresses their shared humanity and pooled expertise 3 is recruited and rewarded for generic skills as well as technical expertise 4 builds a career which is fluid across sectors and services 5 combines an ethos of publicness with an understanding of commerciality6 is rethinking public services to enable them to survive an era of perma-austerity7 needs organisations which are fluid and supportive rather than silo-ed and controlling8 rejects heroic leadership in favour of distributed and collaborative models of leading9 is rooted in a locality which frames a sense of loyalty and identity

8 .1 A 21st Century workforce

As the public services reform and health and care integration takes hold, it is important to consider the skills and attributes of our workforce in Lancashire and beyond. The workforce needs to be enabled to make every contact with our residents count towards their wellbeing. This is particularly relevant for staff working with vulnerable and complex individuals and families where they need to act as the lead professionals. Research conducted by the Birmingham University has identified a series of characteristics which are associated with the 21st Century Public Servant10.

We need to embrace these attributes when considering our workforce development plans across the public sector.

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11 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384650/NIB_Report.pdf

8 .3 Harnessing the power of digital technology

Personalised Health and Care 2020 is a framework for action by the National Information Board to use data and technology to transform outcomes for citizens and patients. It describes that in the airline industry 70% of flights are booked online and 71% of travellers compare more than one website before purchasing. A paper ticket was once a critical ‘trusted’ travel document, yet today around 95% of tickets are issued digitally as e-tickets. In Britain we use our mobile phones to make 18.6 million banking transactions every week; automation of particular services has helped cut costs by up to 20% and improved customer satisfaction. More than 22 million adults now use online banking as their primary financial service11.

In 2014 59% of all citizens in the UK have a smartphone and 84% of adults use the internet; however, when asked, only 2% of the population report any digitally enabled transaction with the health and care services. There is also evidence that people will use technology for health and care, given the opportunity. There are 40 million uses of NHS Choices every month, of which some 5 million are views by care professionals who regard this service as a trusted source of information and advice. The internet-based sexual and general health service, Dr Thom (now part of Lloyds online), has seen 350,000 individuals sign up as users.

In Airedale, West Yorkshire, care home residents have quickly embraced an initiative that gives them the opportunity to tele-access clinicians from the local hospital over a secure video link. A reduction in local hospital admissions

of more than 45% has been reported among that group of people.

Used appropriately, technology could help transform care via telehealth, telecare, mobile applications and social media, and by timely information sharing between care professionals. NHS FYFV and the Sustainability and Transformation Plan requires each area to develop a digital road map by June 2016.

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9 Key actions to secure our health and wellbeing We need to develop Lancashire as a County of Wellbeing. It involves addressing the wider determinants of health and wellbeing, mobilising individuals and communities to develop resilience, achieving sustainable behaviour and lifestyle changes, and joining up our services at neighbourhood level with the needs of the individuals and families at the centre.

The following recommendations are based on the analysis of the health

outcomes and their determinants in Lancashire. They are aimed to promote wellbeing, prevent ill health and prolong quality of life. They cannot be solely achieved by a single organisation and therefore requires partnership working across Lancashire. They are intentionally broad and complement the start well, live well and age well elements of Lancashire’s Health and Wellbeing strategy. They form the basis for public health action and the prevention efforts across the public services.

Implemented alongside other initiatives in the context of NHS Five Year Forward View and the Sustainability and Transformation Plan, they are highly likely to help achieve the Triple Aim in Lancashire. Progress on the recommendations will be reported in the subsequent reports of the Director of Public Health.

Create the conditions for wellbeing and healthA Ensure a best start in life for our children and young people, including systematically implementing the healthy child

programme12 across Lancashire.B Achieve year on year improvement on all the Marmot indicators for socioeconomic and environmental determinants of health. C Systematically proliferate the grass roots community development approaches that we have already got to mobilise and build

community capacity to improve our resilience, health and wellbeing. D Promote healthy living environments by addressing the variation in road safety (particularly for children), housing standards

and fuel poverty, and access to green space, cycling and walking paths across Lancashire. E Facilitate the development of a Dementia Friendly Lancashire by supporting the dementia friendly communities and

programmes to support raising awareness, early detection and supporting people with dementia.

12 https://www.gov.uk/government/publications/healthy-child-programme-rapid-review-to-update-evidence

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Enable Sustainable behaviour and lifestyle changes

F Continue to enable the citizens of Lancashire to adopt healthier lifestyles through a comprehensive behaviour change approach to tackle smoking, physical inactivity, obesity, alcohol consumption.

G Promote workplace wellbeing by encouraging the businesses and other public sector bodies in Lancashire to adopt the workplace wellbeing charter.

Ensure we have a joined up public service to provide right care at the right time at the right place

H Adopt a neighbourhood based approach to identify and deliver care, paticulary in supporting the most vulnerable and complex individuals and families across all ages through a joined up targeted early help and crisis support across the public services sector.

I Improve access to support emotional wellbeing of our children and young people and social isolation/loneliness in older people.

J Support individuals with long term conditions and their carers with self-management tools to promote their independence and reduce emergency admissions.

K Achieve continuous improvement on the quality of care and savings opportunities across the care pathways from prevention to end of life care, and supporting complex individuals as identified by the NHS Right Care programme.

Develop the right environment for public service innovation and improvement

L Develop a digital roadmap that embraces the opportunities presented by the digital technologies, internet and the social media to achieve the Triple Aim.

M Support the development of core competencies for place based working across the public sector workforce, including their ability to make every contact count to improve the wellbeing of the residents and communities they serve.

Get the latest from Lancashire County CouncilVisit www.lancashire.gov.uk and sign up for regular updatesFacebook.com/lancashireccTwitter.com/lancashirecc

Declaration of members’ interests West Lancashire Clinical Commissioning Group Governing Body Meeting – 26 July 2016 1


WEST LANCASHIRE CLINICAL COMMISSIONING GROUP BOARD REPORT

DATE OF BOARD MEETING: 26 July 2016 TITLE OF REPORT: Declaration of Members’ Interests - Update BRIEFING POINTS: To record the declared interests of the members of

West Lancashire Clinical Commissioning Governing Body


A. Commissioning Board’s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient

experience) – please outline impact No


No


No

4. Delivering Financial Balance – please outline impact No 5. Development of the commissioning group as a commissioning

organisation – please outline impact Yes

Will provide the commissioning board and commissioning group with practical experience of implementing good governance practices

B. Governance – please outline impact Yes 1. Does this report:


• have any legal implications • promote effective governance practice

The report promotes good governance practices. It provides a summary of the declared interests of members. Since the register was first presented to the governing body additional posts have been recruited to.


No

3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PRESENTED BY:

Paul Kingan, Chief Finance Officer


WEST LANCASHIRE CLINICAL COMMISSIONING GROUP BOARD

DECLARATION OF MEMBERS’ INTERESTS - UPDATE BACKGROUND

1. The purpose of this report is to record the declared interests of the members of West Lancashire Commissioning Governing Body.

2. The register was updated in June 2016 to provide an up to date position of declarations of interest for the members of the Governing Body.

ACTIONS

3. The Governing Body is asked to:

a. note the declared interests of its members.


NHS West Lancashire Clinical Commissioning Group Register of Interests

30 June 2016 Name Date Position / Role Potential or actual area where interest

could occur Action taken to mitigate risk

Comments

GOVERNING BODY DECLARATION OF INTERESTS Dr J Caine * 27.6.16 Chair • GP partner: Parbold Surgery

• Wife employed by Southport and Ormskirk NHS Hospital Trust as a paediatric nurse in A&E.

Conflict of interest policy in place. Declaration of interest on all agendas.

Dr B S Biswas * 14.6.16 GP executive lead

• Partner Beacon Primary Care • Partner in North Meols Medical Centre • Director (50% Shares) in BARBONEL a

property services company • Wife is a family planning nurse

employed by Blackpool GUM, which provides local services via Local Authority.

• Practice subscribes to OWLs. • LES provider anticoagulation and minor

operations.


Dr S Frampton * 16.6.16 GP executive lead

• GP Partner at Ormskirk Medical Practice providing clinical and business management roles.


Dr J Kinsey * 14.6.16

GP executive lead

• Partner in Parbold surgery, 4 The Green, Parbold WN8 7DN (3 days per week)

Conflict of interest policy in place. Declaration of


• Owner, director and shareholder (70%) of JPK medical Ltd

• Medical Consultant for Pharmaco-vigilance at Ayrton Saunders Ltd

• Primary care medical educator and programme director for Manchester postgraduate Deanery as an educator at Preston

• Out of hours provider – work for OWLS CIC Ltd as independent practitioner for GP services in West Lancashire.

• Wife works as Macmillan upper GI cancer nurse specialist at Aintree NHS Foundation Trust.

• Wife is a shareholder (30%) and co-owner of JPK medical ltd.

• Brother in law – co-owner and director shareholder (60%) of Mednostic solutions ltd (family members)

o Diagnostic provider (osteoporosis Dexa scanning)

o Weight loss services o Sports science

interest on all agendas.

Paul Kingan

4.7.16 Chief finance officer

Nil

Douglas Richard Soper

21.6.16 Lay member audit and governance

Nil

Greg Mitten

28.6.16 Lay member patient and public involvement,

• Chief Officer, West Lancashire Community for Voluntary Services Director Lancashire Association of CVS (Charity).

Conflict of interest policy in place. Declaration of interest on all


Chair of CCG Quality and Safety Committee

Chair of One West Lancs -strategic partnership. (Voluntary position). Chair – Lancashire West LAG (RDPE) Board (Voluntary position) Member Governing Body – Hilldale Primary School Wife (Dierdre Mitten) is project director of Skelmersdale Food Initiative – Charity. (family member interest)

agendas.

Adam Robinson

30.6.16 Secondary care doctor

• Deputy chair of Salford Healthcare


Michael Maguire 30.6.16 Chief officer Daughter to visit Deloitte in Manchester to receive an overview of the Deloitte role. (One day)


Dr R Bonsor* 10.3.16 GP executive lead

• GP partner and GP Trainer at Beacon Primary Care Ormskirk and Skelmersdale.

• Director of Barbonel services company. • Fundraising for Lancashire Defibrillator

Campaign • Chair of local 30th Ormskirk Scout

Group. • Fundraiser for West Lancashire Defib

Group, Chair a personal friend (Personal and friend).

• Ambassador for Twinkle House Charity



Skelmersdale, is a personal friend. • Director or Home Instead a personal

friend. • Practice performs minor surgery,

vasectomy, anticoagulation and family planning services and the £5 per head proactive cover scheme.

• Husband is a consultant in Accident and Emergency at Whiston Hospital (family member interest).

• Practice nurse clinician is partner of the local manager of the Older Adult Mental Health team (Professional relationship interest).

Claire Heneghan 30.6.16 Chief Nurse Nil

Dr Peter Gregory* 27.6.16 GP executive lead

• Partner at Parkgate surgery • Director of OWLs • Member of shadow board within Health

Partnerships (WL GP Provider organisation). Company not yet invested.

• Brother is a fellow of AQUA (family member interest)

• Perform minor surgery/injections for own practice.


Dr Vikul Mittal* 14.6.16 GP executive lead

• GP partner at Tarleton Group Practice • Director of OWLs out of hours • Wife, Dr Rashmi Gupta in consultant

microbiologist at Southport and Ormskirk District General Hospital.


Dr Rakesh Jaidka* 14.6.16 GP executive

lead • GP partner at Skelmersdale Family

Practice • Director for OWLs OOH • LMC representative for West

Lancashire.

*As agreed at the Governing Body meeting on 28 January 2014, please note that all principal GPs in West Lancashire are default members of the Out of Hours service.


NHS West Lancashire Clinical Commissioning Group Declaration of interests - members

This form is required to be completed in accordance with the CCG’s Constitution and

section 14O of The National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition) regulations 2013 and the Substantive guidance on the Procurement, Patient Choice and Competition Regulations.

Name ……………………………………………….. (BLOCK CAPITALS) Position within or relationship with, the CCG or NHS England ………………………………………………………………………………………………. I hereby declare my interests as follows: Type of interest Details Personal interest or

that of a family member, close friend or other acquaintance?

Role and responsibilities held within member practices

Membership of any GP provider organisation holding or seeking to hold CCG contracts

Membership of the Operating Board of such organisations

Directorships, including non-executive directorships held in private companies or PLCs

Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or NHS England


Share holdings (more than 5%) of companies in the field of health and social care

A position of authority in an organisation (eg. Charity or voluntary organisation) in the field of health and social care.

Any connection with a voluntary or other organisation contracting for NHS services.

Research funding/grants that may be received by an individual or any organisation in which they have an interest or role

Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared)

Any interests in relation to the CCG’s Enhanced Services Review

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgment or actions in their role within the CCG and/or with NHS England.

Any other interests


To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly. I give my consent for the information to be recorded in a formal Register of Interests, a public document which will be published on a quarterly basis and available for inspection upon request by the general public. Signed: …………………………………………………… Date: …………………… Please complete and return to: Cathy Ashcroft, board secretary, West Lancashire CCG

Healthier Lancashire Joint Committee of CCG’s – Terms of Reference West Lancashire Clinical Commissioning Group Board Meeting – 26 July 2016

1

WLCCGB 07/16/12 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP

GOVERNING BODY REPORT DATE OF BOARD MEETING: 26 July 2016 TITLE OF REPORT: Healthier Lancashire Joint Committee of CCG’s -

Terms of Reference BRIEFING POINTS:

To present a further draft of the Terms of Reference (ToR), of the Joint Committee of Clinical Commissioning Groups, to the voting and non-voting membership organisations; and requesting a ‘Minute of Decision’ in order to establish the JC CCGS and to commence the next phase of the Healthier Lancashire & South Cumbria Change Programme.




Yes

Quality aspects of Lancashire/South Cumbria change programme


Yes

Facilitates decision-making for collaborative pan-Lancashire work-streams


No


Facilitates potential joint QIPP schemes across wide geography


Yes

Allows for decision-making on a collaborative basis to facilitate STP work-streams



provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number)



Yes

Yes Yes

Helps to facilitate clinical and financial solutions as stated in the 5 year forward view


Yes

The CCG will contribute to running costs of the Lancashire & South Cumbria change programme

Healthier Lancashire Joint Committee of CCG’s – Terms of Reference West Lancashire Clinical Commissioning Group Board Meeting – 26 July 2016

2


Shared learning across a wide footprint



There will be more collaboration across CCG’s


There will be wider patient and public engagement across Lancashire/South Cumbria

REPORT PRESENTED BY:

Paul Kingan, Chief Finance Officer

Name of Paper Establishing the Joint Committee of Clinical Commissioning Groups (JC CCGS)

Lead Author Samantha Nicol ,Healthier Lancashire Director

Contributors

Purpose of Paper To present a further draft of the Terms of Reference (ToR), of the Joint Committee of Clinical Commissioning Groups, to the voting and non-voting membership organisations; and requesting a ‘Minute of Decision’ in order to establish the JC CCGS and to commence the next phase of the Healthier Lancashire & South Cumbria Change Programme.

Exec Summary On 19th November 2015 at the Executive Leadership Summit

there was agreement to establish a change programme of a

scale to meet the Lancashire challenge. On 30th November

2015 at the governance workshop it was agreed that a Joint

Committee of Clinical Commissioning Groups (JC CCGs) was

the correct decision making vehicle for such a programme.

With the advent of the NHS Planning Guidance in December

2015 South Cumbria agreed to be included as the Lancashire

and South Cumbria footprint and therefore a named part of

the Programme that had been known as Healthier

Lancashire.

The first draft of the Terms of Reference for the Joint

Committee, the Scheme of Delegation and notes were

circulated on 23rd March 2016 with any comments and the

‘Minute of Decision’ to be returned by 29th April 2016.

The second draft of the Terms of Reference for the Joint

Committee were circulated on 29th April 2016. At the

Collaborative Commissioning Board meeting on 10th May

2016 a Questions and Answer session with Gerard Hanratty

from Capsticks was requested.

The QA session with Gerard Hanratty for CCG Accountable

officers, Chairs and Lay members was held on 14th June 2016.

As an outcome of that session the Terms of Reference for the

JCCCGs have been updated and draft three is attached.

To reiterate key points or decisions that were made during

the QA session:

The primary purpose of the JCCCGs is decision making on pertinent Lancashire and South Cumbria-wide commissioning issues that arise from the Lancashire and South Cumbria Change programme.

The JCCCGs will have an Independent Chair

The process to recruit an Independent Chair can

commence

JCCCGs dates can be set for the Design Phase when it

is appropriate for the JCCCGs to be convened.

Gerard Hanratty has reviewed the CCG Constitutions

and advised where amendments would be needed.

These are set out in the attached paper.

Recommendations The Board/Governing Body is asked to:

Consider and agree the revised draft JC CCGs ToR and note the amendments

Provide a ‘Minute of Decision’ (as set out on the final page of the note accompanying the ToR) and advise us of the names of the voting representatives to be included on the JC CCGS and allow a first meeting to be called

Where CCG Constitutional amendments are required the relevant Governing Bodies consider these amendments.

Next steps Following receipt of the ‘Minute of Decision’ from member organisations with the details of their representatives on the JC CCGS a first meeting of the JC CCGS will be called. A decision making matrix to be developed, in an appropriate format.

Introduction

1.1. On 19th November 2015 at the Healthier Lancashire Executive Leadership Summit, which was facilitated by Dame Ruth Carnall, from CarnallFarrar LLP the need for a programme of the scale and ambition, outlined in the Alignment of the Plans Report, was confirmed; to address the Lancashire challenge and deliver a sustainable health and care system for Lancashire.

1.2. On 30th November 2015 the same leaders participated in a governance workshop,

facilitated by Gerard Hanratty from Capsticks LLP and the proposed governance and programme structure was recommended to the Clinical Commissioning Groups, as sponsors of Healthier Lancashire, as being the effective mechanism for a programme of the required scale and ambition.

1.3. Specifically the clinical commissioning groups (CCGs) confirmed that the correct

decision making vehicle was a joint committee of clinical commissioning groups (JC CCGs).

1.4. With this agreement, Gerard Hanratty was instructed to develop a draft ToR for the JCCCGs, which was circulated to the proposed voting and non-voting member organisations, on 23rd March, for them to return a ‘Minute of Decision’ stating their proposed representatives. The ToR was also circulated to all other organisations who are partners in Lancashire and South Cumbria Change Programme for their information.

1.5. The second draft of the JCCCGs ToR reflected the change in relation to it considering

only the recommendations made in relation to the Lancashire and South Cumbria Programme, with all other collaborative commissioning decisions continuing through the existing Collaborative Commissioning Board.

1.6. The attached third draft of the JCCCGs ToR reflects the discussion at the Questions

and Answer session with Gerard Hanratty on 14th June 2016 with Collaborative Commissioning Board members, Chairs and lay members.

2. Establishing the JC CCGS

2.1. The attached JCCCGs ToR is the third draft, following feedback from organisations

who are engaged in a collaborative programme, known as Lancashire and South Cumbria Change Progamme. Lancashire and South Cumbria Change Programme has also been agreed as the vehicle through which the Lancashire and South Cumbria Sustainability and Transformation Plan will be co-produced as a ‘regional’ strategy with local decision making and delivery.

2.1.1. The first draft of the JCCCGs ToR was circulated to all voting and non-voting members by email on 23rd March 2016 asking for them to return a ‘Minute of Decision’ stating who their representatives would be on the JCCCGs and any other comments by 29th April 2016.

2.1.2. It was circulated to other Healthier Lancashire partner organisations for information and comment at the same time.

2.1.3. Further advice was sought from Gerard Hanratty, Capsticks LLP, on 27th April 2016, based on the feedback received to date. Mr Hanratty made the required ‘legal’ changes to the second draft of ToR and schedule of delegation.

2.1.4. The second draft of the JCCCCGs ToR was circulated to all voting and non-voting members by email on 29th April 2016.

2.1.5. Further advice was sought from Gerard Hanratty, Capsticks LLP at the QA session on 14th June. Mr Hanratty made the required changes and added the clarity where requested to produce the third draft of the ToRs (attached).

2.1.6. The ToR recognise, through the title of the programme, the inclusion of South Cumbria, in light of their agreement to form the Lancashire and South Cumbria Sustainability and Transformation Plan footprint. As yet they are not shown as members of the JCCCGs as discussions are on-going in relation to the governance arrangements across Morecambe Bay and their local system programme, Better Care Together.

2.2. There is a requirement for a decision making matrix, given the complexity of the

Lancashire and South Cumbria Change Programme, and in light of approaches being taken by other local and national programmes, the format of this is under development, but will be created and discussed by the JCCCGs prior to adoption.

2.2.1. Realistically the decision making matrix will be best constructed through the work of the Programme and for the JCCCGs requirement to work through any proposals arising from the Programme and their impact and consequences and collating these. The ToR as they stand will ensure that there is an appropriate legal framework in place to allow this.

2.2.2. There has also been a call for a dispute resolution process and again this will be dependent on the types of decisions taken at the JCCCGS and so this will follow the agreement and adoption of the decision making matrix.

3. Amendments to CCG Constitutions 3.1. Gerard Hanratty has reviewed the Lancashire and South Cumbria CCG Constitutions

and made the following observations:

Constitutions which do not require amendments 3.1.1. Blackpool – all model clauses included and there is some additional text at the

end of paragraph 6.5.1.11 but it reflects what Mr Hanratty has put in paragraph 15 of the ToR. No changes required.

3.1.2. East Lancashire – all model clauses included, although a couple of incorrect references to clauses in constitution but just typographical that can be tidied up. No changes required.

3.1.3. Lancashire North – all model clauses included.

Constitutions which require possible amendments 3.1.4. Fylde and Wyre – all model clauses included and some minor amendments to

draft wording. 3.1.5. Greater Preston – version Mr Hanratty has seen only has model clause for joint

commissioning with NHS England, so clauses for joint commissioning with CCGs needs to be added.

3.1.6. Chorley & South Ribble - version Mr Hanratty has seen only has model clause for joint commissioning with NHS England, so clauses for joint commissioning with CCGs needs to be added.

3.1.7. Blackburn with Darwen - version Mr Hanratty has seen only has model clause for joint commissioning with NHS England, so clauses for joint commissioning with CCGs needs to be added.

Constitutions which require amendments 3.1.8. West Lancashire – none of model clauses in version Mr Hanratty has seen.

3.1.9. Cumbria - none of model clauses in version Mr Hanratty has seen.

3.2. Actions needed for CCG Constitutions that require amendments

3.3. Mr Hanratty reviewed Constitutions that were available on CCG websites; therefore if there is a more up to date version these should be sent to [email protected].

3.4. Where CCG Constitution amendments have been identified as being required Mr Hanratty has advised: “If the clauses have been included then the relevant CCGs just need to confirm whether they have simply adopted the model or made some amendment and if they have amended then provide a copy of the amended clauses”.

3.5. A letter will be sent to the CCGs whose constitutions require amendments. The letter

will set out the joint commissioning clause that needs to be added and the support available from Capsticks LLP.

3.6. These amendments do not preclude the agreement or minute of decision and

establishing of the JCCCGs.

4. Risks 4.1. On the Lancashire and South Cumbria Change Programme Risk Register there is one

risk relating to the JCCCGS. This risk and its mitigation are currently rated as 8 and it remains under monthly consideration through the Programme Management Group.

5. Conclusion 5.1. The third draft of the ToR reflects the consensus reached at the Questions and Answer

Session on 14th June.

5.2. There is a pressing need to now have confirmed the named representatives from the voting and non-voting member organisations in order to call the first JCCCGs meeting together.

5.3. The amendments to CCG Constitutions do not preclude the agreement or minute of

decision and establishing of the JCCCGs.

6. Recommendations 6.1. The Governing Body is asked to:

Consider and agree the revised draft JCCCGs ToR and note the amendments Note that the ToR and the notes on creating the JCCCGs which offers definitions

and an explanation remain draft, but these are not detrimental to establishing the JCCCGs

Provide a ‘Minute of Decision’ and advise us of the names of the voting representatives to be included on the JCCCGs and allow a first meeting to be called

mailto:[email protected]

To take the necessary steps required in relation to the actions to amend CCG Constitution (where applicable)

7. Next Steps

Following receipt of the ‘Minute of Decision’ from member organisations with the details of their representatives on the JCCCGs a first meeting of the JCCCGs will be called.

The first task of the JCCCGs will be to consider and agree the ToR.

Agree to develop the decision making matrix and dispute resolution through the JCCCGs.

For the JCCCGs to receive and consider the Lancashire and South Cumbria Programme’s Case for Change.

This paper was produced by Samantha Nicol, Lancashire & South Cumbria Change Programme Director

Date 11th July 2016

Contact details Lynn Chadwick, PA – 01253 951611

Email: [email protected]

Lancashire & South Cumbria Change

Programme

Terms of Reference:

JC CCG

Responsible Person: Joint Committee Chair Date Approved: Approval Committee: Document Control:

Amendment History:

NB. The version of the policy posted on the intranet must be a PDF copy of the approved version.

Document Status: This is a controlled document. Whilst this document may be printed the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled.

Description Comment

Title Lancashire & South Cumbria Change Programme Terms of Reference: Joint Committee

Document Number 1

Author Ian Tomlinson

Date Created 18th April 2016

Date Last Amended 11th July 2016

Version 3

Approved By

Date Approved

Review Date

Responsible Person/Owner

Publish on Public Web Site Y/N?

Constitutional Document Y/N?

Requires an Equality Impact Assessment Y/N?

Version Date Comment on Changes

1. INTRODUCTION

1.1 The NHS Act 2006 (as amended) (‘the NHS Act’), was amended through the introduction of a

Legislative Reform Order (’LRO’) to allow CCGs to form joint committees. This means that two or more CCGs exercising commissioning functions jointly may form a joint committee as a result of the LRO amendment to s.14Z3 (CCGs working together) of the NHS Act.

1.2 Joint committees are a statutory mechanism which gives CCGs an additional option for

undertaking collective strategic decision making. Whilst NHS England will make decisions on Specialised Commissioning separate from a joint committee, as such decisions cannot be delegated to a CCG or a joint committee of CCGs, they can still make such decisions collaboratively with CCGs.

1.3 Although the Lancashire and South Cumbria Change Programme (‘the Programme’) will affect

services commissioned by the Specialised Commissioning function of NHS England it has been decided that decisions on those services will be undertaken on a collaborative basis. This will allow sequential decisions to be undertaken allowing clarity of responsibility but also recognising the linkage between the two decisions.

1.4 Individual CCGs and NHS England will still always remain accountable for meeting their

statutory duties. The aim of creating a joint committee is to encourage the development of strong collaborative and integrated relationships and decision-making between partners.

1.5 The Joint Committee of Clinical Commissioning Groups (‘JC CCGs’) is a joint committee of:

Blackburn with Darwen CCG; Blackpool CCG; Chorley & South Ribble CCG; East Lancashire CCG; Fylde & Wyre CCG; Greater Preston CCG; Lancashire North CCG; West Lancashire CCG. With Cumbria CCG invited to be an associate member of the JC CCGs with no voting rights.

1.6 The primary purpose of the JC CCGs is decision making on pertinent Lancashire and South

Cumbria wide commissioning issues that arise from the Programme. 1.7 In addition, the JC CCGs will meet collaboratively with NHS England to make integrated

decisions in respect of those services within the Programme which are directly commissioned by NHS England.

1.8 The Programme - Health leaders across the Lancashire and South Cumbria area have

collectively committed to change the way certain elements of health care are provided to the local population to deliver the highest quality of care possible within the resources available. The work of the Programme is designed to deliver key clinical standards consistently across the patch so that all people receive the highest possible care and best outcomes. The relevant clinical work streams which the JC CCGs will consider under the Programme are:

Acute and specialised

Urgent & Emergency care

Mental Health

Population Health model

Population integrated locality delivery model

1.9 Currently for those people who do need in-hospital treatment care can be variable in terms of

outcomes because not all hospitals or services meet the agreed clinical quality standards, the hospitals are competing to provide the same services in a health economy that is constrained by both finance and capacity, particularly certain elements of the workforce, to deliver services at the levels required. From the work carried out to date, it is clear that it is not sustainable to carry on without changing the way health services are delivered both regionally and locally.

1.10 Guiding principles

The Lancashire and South Cumbria Change Programme is proposing to adhere to the following principles as a minimum:

People and patients come first – delivering parity of esteem and outcomes – fairness and

timeliness of access to support.

Delivering a clinically and financially sustainable health and care system across Lancashire

and South Cumbria (‘L&SC’).

Clinically-led, co-design and collaboration across L&SC Health & Care System delivering

integrated support.

Aligning priorities across Local Health and Care Systems and organisations – managing

sovereignty and risk.

Prioritised effort on greatest benefit – improving quality and outcomes efficiently and

effectively.

Ensuring Value for Money. Doing things right and doing the right things.

Alignment of effort and resource – ‘twin citizenship’ of staff for L&SC and local levels.

Built upon innovation, international evidence and proven best practice.

Subsidiarity with clear framework of mutual accountability.

The Programme will establish a Programme Board to oversee the development of agreed clinical quality standards, a feasibility analysis looking at the implications of implementing these standards, a clinical case for change, a financial case for change and a model of care.

2. STATUTORY FRAMEWORK

2.1 The NHS Act which has been amended by LRO 2014/2436, provides at s.14Z3 that where two

or more clinical commissioning groups are exercising their commissioning functions jointly,

those functions may be exercised by a joint committee of the groups.

2.2 The CCGs named in paragraph 1.5 above have delegated the functions set out in Schedule 1 to

the JC CCGs.

3. ROLE OF THE JC CCGs 3.1 The role of the JC CCGs shall be to carry out the functions relating to decision making on

pertinent Lancashire and South Cumbria wide commissioning issues that arise from the

Programme.

3.2 In relation to Acute and Specialised Services - The JCCCG will collaborate with NHS England, on

that which is theirs to commission in relation to aspects as yet to be agreed, but leading is the

delivery on an agreed L&SC strategy aligned to national conditions.

3.3 In relation to Urgent and Emergency Care (UEC) – The JCCCG will ensure that national

standards are delivered and that there is in place an agreed UEC model developed against

theses with all interdependencies mapped and considered.

3.4 Mental Health – The JCCCGs will recognise that this programme encompasses all ages and

people with learning disabilities. Decisions will relate to the development of parity of esteem

and delivery of national strategies. This will be done through clarity of relevant pathways and

understanding what the potential reconfiguration aspects are to then agree JCCCG decisions

and local decisions.

3.5 In relation to Population Health Model – The JCCCG will provide strategic input into the

delivery of a Population Health Model to the member CCGs across the region. This will enable

the member CCGs to make local decisions in alignment with the regional strategic objective.

3.6 In relation to Population Integrated Locality Delivery Model and the services contained within

– The JCCCG will provide strategic input to member CCGs across the region. This will enable

the member CCGs to make local decisions in alignment with the regional strategic objectives.

3.7 This includes, but is not limited to, the following activities:

Determine the options appraisal process;

Determine the method and scope of the engagement and consultation processes;

Act as the formal body in relation to consultation with the Joint Overview and Scrutiny

Committees established for this Consultation by the relevant Local Authorities;

Make any necessary decisions arising from a Pre-Consultation Business Case (and the

decision to run a formal consultation process);

Approve the Consultation Plan;

Approve the text and issues on which the public’s views are sought in the Consultation

Document;

Take or arrange for all necessary steps to be taken to enable the CCG to comply with

its public sector equality duties;

Approve the formal report on the outcome of the consultation that incorporates all of

the representations received in response to the consultation document in order to

reach a decision;

Make decisions about future service configuration and service change, including but

not exclusively relating to the work on consolidation and the reconfiguration of acute

services across L&SC, taking into account all of the information collated and

representations received in relation to the consultation process. This should include

consideration of any recommendations made by the Programme Board or views

expressed by the Joint Health Overview and Scrutiny Committee or any other relevant

organisations and stakeholders.

3.8 At all times, the Joint Committee, through undertaking the decision making function of each

member CCG will act in accordance with the terms of their constitutions. No decision outcome

shall impede any organisation in the fulfilment of its statutory duties.

4. GEOGRAPHICAL COVERAGE

4.1 The JC CCGs will comprise those CCGs listed above in paragraph 1.5 and cover the Lancashire

and South Cumbria region.

4.2 NHS England Specialised Commissioning (tbc) will also be involved through a collaborative commissioning arrangement.

4.3 The Joint Committee will have the primary purpose of decision on pertinent Lancashire and South Cumbria wide commissioning issues that arise from the Programme.

5. MEMBERSHIP

5.1 Membership of the committee will combine both Voting and Non-voting members and will

comprise of: - 5.2 Voting members:

The two individuals appointed to represent each of the member CCGs, subject to such

voting being in compliance with paragraph 7 below on ‘Voting’.

[Whilst the JC CCG does not require a clinical majority the CCG members should ensure it consists of clinicians, lay members and executives.] 5.3 Non-voting attendees:

The Independent Chair of the Joint Committee;

A vice chairman to be elected from the membership of the JC CCGs by the members and

who will retain their voting rights.

The Senior Responsible Officer for the Programme;

The Assistant Director NHS England Specialised Commissioning will be invited to each

meeting in a non-voting capacity;

A Healthwatch representative nominated by the local Healthwatch groups;

Such representation from the Combined and/ or Local Authorities as the JC CCG deems

appropriate.

The Clinical Lead for the Programme

The Lead for the Prevention and Wellbeing Programme

The Chairs of:

The Care System Design Board

Finance and Investment Group

Programme Director and Chair of the Programme Management Group.

5.4 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Joint Committee. All deputies should be fully briefed and the secretariat informed of any agreement to deputise so that quoracy can be maintained.

5.5 No person can act in more than one role on the Joint Committee, meaning that each deputy needs to be an additional person from outside the Joint Committee membership.

5.6 The Programme Director (supported by the Programme Management Group) will act as secretariat to the Committee to ensure the day to day work of the Joint Committee is proceeding satisfactorily. The membership will meet the requirements of the constitutions of the CCGs named above at paragraph 1.5.

6. MEETINGS

The Joint Committee shall adopt the standing orders of Blackpool CCG insofar as they relate to the:

a) notice of meetings

b) handling of meetings

c) agendas

d) circulation of papers

e) conflicts of interest

7. VOTING 7.1 The Joint Committee will aim to make decisions by consensus wherever possible. Where this is

not achieved, a voting method will be used. The voting power of each individual present will be weighted so that each party (CCG) possesses 12.5% of total voting power.

7.2 It is proposed that recommendations can only be approved if there is approval by more than 75%.

8. QUORUM

At least one full voting member from each CCG must be present for the meeting to be quorate.

9. FREQUENCY OF MEETINGS

Frequency of meetings will usually be monthly, but as and when required.

10. MEETINGS OF THE JOINT COMMITTEE

10.1 Meetings of the Joint Committee shall be held in public unless the Joint Committee considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Therefore, the Joint Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10.2 Members of the Joint Committee have a collective responsibility for the operation of the Joint

Committee. They will participate in discussion, review evidence and provide objective expert input to the best of the knowledge and ability, and endeavor to reach a collective view.

10.3 The Joint Committee may call additional experts to attend meetings on an ad hoc basis to

inform discussions. 10.4 The Joint Committee has the power to establish sub groups and working groups and any such

groups will be accountable directly to the Joint Committee. 10.5 Members of the Joint Committee shall respect confidentiality requirements as set out in the

Standing Orders referred to above unless separate confidentiality requirements are set out for the Joint Committee in which event these shall be observed.

11. SECRETARAIT PROVISIONS [ to be provided by Programme Management Office]

The secretariat to the JC CCG will:

Circulate the minutes and action notes of the committee within three working days of the

meeting to all members

Present the minutes and action notes to the governing bodies of the CCGs set out in 4

above.

12. REPORTING TO CCGS AND NHS ENGLAND

The Joint Committee will make a quarterly written report to the CCG member governing bodies and NHS England and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

13. DECISIONS

13.1 The Joint Committee will make decisions within the bounds to the scope of the functions delegated.

13.2 The decisions of the Joint Committee shall be binding on all member CCGs, which are: Blackburn with Darwen CCG; Blackpool CCG; Chorley & South Ribble CCG; East Lancashire CCG; Fylde & Wyre CCG; Greater Preston CCG; Lancashire North CCG; and West Lancashire CCG. With Cumbria CCG invited to be an associate member of the JC CCGs with no voting rights.

13.3 All decisions undertaken by the Joint Committee will be published by the Clinical Commissioning Groups set out in paragraph 15.2, above.

14. REVIEW OF TERMS OF REFERENCE

These terms of reference will be formally reviewed by Clinical Commissioning Groups set out in paragraph 15.2 at least annually, taking the date of the first meeting, following the year in which the JC CCG is created and may be amended by mutual agreement between the CCGs at any time to reflect changes in circumstances as they may arise.

The power to add Cumbria CCG as a full member with voting rights to the JC CCGs is delegated to the JC CCGs itself.

15. WITHDRAWAL FROM THE JOINT COMMITTEE

Should this joint commissioning arrangement prove to be unsatisfactory, the governing body of any of the member CCGs or NHS England can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

16. SIGNATURES

Blackburn with Darwen CCG Blackpool CCG

Chorley & South Ribble CCG East Lancashire CCG

Fylde & Wyre CCG Greater Preston CCG

Lancashire North CCG West Lancashire CCG

Schedule 1 - Delegation by CCGs to Joint Committee

A. The following CCG functions will be delegated to the Joint Committee of CCGs (‘the JC CCGs’)

by the member CCGs in accordance with their statutory powers under s.14Z3 of the NHS Act

2006 (as amended). s.14Z3 allows CCGs to make arrangements in respect of the exercise of

their functions and includes the ability for two or more CCGs to create a Joint Committee to

exercise functions. The delegated functions relate to the health services provided to the

member CCGs by all providers they commission services from in the exercise of their functions.

B. The Lancashire and South Cumbria Change Programme (‘the Programme’) focuses on achieving

clinical quality standards in the services listed below provided by the NHS Trusts named above.

As part of this work it is necessary to consider interdependencies between these services and

any other services that are affected. The relevant services are:

a. All elements of the Programme, including the Case for Change, evaluation criteria, options,

communications plan and such like.

b. Such other services not set out above which the CCG members of the JC CCGs determine

should be included in the programme of work.

C. Each member CCG shall also delegate the following functions to the JC CCGs so that it can

achieve the purpose set out in (A) above:

a. Acting with a view to securing continuous improvement to the quality of commissioned

services in so far as these services are included within the scope of the Programme. This

will include outcomes for patients with regard to clinical effectiveness, safety and patient

experience to contribute to improved patient outcomes across the NHS Outcomes

Framework

b. Promoting innovation in so far as this affects the services included within the scope of the

Programme, seeking out and adopting best practice, by supporting research and adopting

and diffusing transformative, innovative ideas, products, services and clinical practice

within its commissioned services, which add value in relation to quality and productivity.

c. The requirement to comply with various statutory obligations, including making

arrangements for public involvement and consultation throughout the process. That

includes any determination on the viability of models of care pre-consultation and during

formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the NHS Act 2006

(as amended) (‘the Act’)

d. The requirement to ensure process and decisions comply with the four key tests for

service change introduced by the last Secretary of State for Health, which are:

Support from GP commissioners;

Strengthened public and patient engagement;

Clarity on the clinical evidence base;

Consistency with current and prospective patient choice.

e. The requirement to comply with the statutory duty under s.149 of the Equality Act 2010

i.e. the public sector equality duty.

f. The requirement to have regard to the other statutory obligations set out in the new

sections 13 and 14 of the NHS Act. The following are relevant but this is not an exhaustive

list:

13C and 14P - Duty to promote the NHS Constitution

13D and 14Q - Duty to exercise functions effectively, efficiently and economically

13E and 14R – Duty as to improvement in quality of services

13G and 14T - Duty as to reducing inequalities

13H and 14U – Duty to promote involvement of each patient

13I and 14V - Duty as to patient choice

13J and 14W – Duty to obtain appropriate advice

13K and 14X – Duty to promote innovation

13L and 14Y – Duty in respect of research

13M and 14Z - Duty as to promoting education and training

13N and 14Z1- Duty as to promoting integration

13Q and 14Z2 - Public involvement and consultation by NHS England/CCGs

13O - Duty to have regard to impact in certain areas

13P - Duty as respects variations in provision of health services

14O – Registers of Interests and management of conflicts of interest

14S – Duty in relation to quality of primary medical services

g. The JC CCGs must also have regard to the financial duties imposed on CCGs under the NHS

Act 2006 and as set out in:

223G – Means of meeting expenditure of CCGs out of public funds

223H – Financial duties of CCGs: expenditure

223I - Financial duties of CCGs: use of resources

223J - Financial duties of CCGs: additional controls of resource use

h. Further, the JC CCGs must have regard to the Information Standards as set out in ss.250,

251, 251A, 251B and 251C of the Health & Social Care Act 2012 (as amended).

i. The expectation is that CCGs will ensure that clear governance arrangements are put in

place so that they can assure themselves that the exercise by the JC CCGs of their

functions is compliant with statute.

j. The JC CCGs will meet the requirement for CCGs to comply with the obligation to consult

the relevant local authorities under s.244 of the NHS Act and the associated Regulations.

k. To continue to work in partnership with key partners e.g. the local authority and other

commissioners and providers to take forward plans so that pathways of care are seamless

and integrated within and across organisations.

l. The Joint Committee will be delegated the capacity to propose, consult on and agree

future service configurations that will shape the medium and long terms financial plans of

the constituent organisations. The Joint Committee will have no contract negotiation

powers meaning that it will not be the body for formal annual contract negotiation

between commissioners and providers. These processes will continue to be the

responsibility of Clinical Commissioning Groups and NHS England under national guidance,

tariffs and contracts during the pre-consultation and consultation periods.

m. The JC CCGs is given the specific power to make Cumbria CCG a full voting member of the

JC CCGs, including approving appropriate amendments to the ToR for such specific

purpose, when it determines that to be appropriate.

D. The role of the JC CCGs shall be to carry out the functions relating to decision making on

pertinent Lancashire and South Cumbria wide commissioning issues that arise from the

Programme. This includes, but is not limited to, the following activities:

Determine the options appraisal process;

Determine the method and scope of the engagement and consultation processes;

Act as the formal body in relation to consultation with the Joint Overview and Scrutiny

Committees established for this Consultation by the relevant Local Authorities;

Make any necessary decisions arising from a Pre-Consultation Business Case (and the

decision to run a formal consultation process);

Approve the Consultation Plan;

Approve the text and issues on which the public’s views are sought in the Consultation

Document;

Take or arrange for all necessary steps to be taken to enable the CCG to comply with

its public sector equality duties;

Approve the formal report on the outcome of the consultation that incorporates all of

the representations received in response to the consultation document in order to

reach a decision;

Make decisions about future service configuration and service change, taking into

account all of the information collated and representations received in relation to the

consultation process. This should include consideration of any recommendations made

by the Programme Board or views expressed by the Joint Health Overview and Scrutiny

Committee or any other relevant organisations and stakeholders.

At all times, the Joint Committee, through undertaking the decision making function of each

member CCG will act in accordance with the terms of their constitutions. No decision outcome

shall impede any organisation in the fulfilment of its statutory duties.

Schedule 2 - List of Members from each Constituent CCG

[To complete and insert]

Quality and Safety Committee – 28 June 2016 Page 1 of 8

Minutes

Quality and Safety Committee

Venue: Boardroom, Hilldale, Ormskirk

Date & Time: Tuesday 28 June 2016 at 1.00 – 3.00pm

Attendees: Mr G Mitten – Chair Mrs J Mastin - Infection, Prevention, Control Nurse for the Central Locality, Public Health England Dr J Kinsey – GP lead for safeguarding Dr Rakesh Jaidka Debbie Dobson – Practice manager (on behalf of Jo DeBacker)

In attendance: Miss C Ashcroft – Executive assistant Mrs A Sathiyanathan – Quality assurance manager Mrs L Elliott – Lead nurse for safeguarding adults and mental capacity act Mrs L Burton – Designated lead nurse for safeguarding children Mrs Sheralee Turner-Birchall – Chief officer of Healthwatch Lancashire Miss A Gordon – Service redesign manager (on behalf of Carol McCabrey)

Apologies: Mrs J DeBacker – Practice manager Mrs A Lumley – Primary care nurse development lead Mrs C McCabrey – Service redesign manager

Agenda

Item CCGQIC

Summary of Discussion Lead

06/16/1 Welcome and apologies for absence Greg Mitten welcomed the members of the quality and safety committee to the meeting and introductions were made. The apologies above were relayed.

06/16/2 Declaration of interest There were no declarations of interest raised which were pertinent to the agenda. Members will raise any relevant declarations of interest as each item is discussed.

06/16/3 Minutes from the previous meeting on 26 April 2016 The notes from the previous meeting were approved as a correct record of the meeting.

06/16/4 Matters arising – action sheet The action sheet was updated.

06/16/5 Patient Quality, Performance, Safety and Experience a. Integrated business report (IBR)

Allison Sathiyanathan asked for comments and suggestions for the new IBR format. Greg Mitten commented that as some quality issues have recurred for some time, assurance is needed that the quality issues being raised at the committee are being addressed by the Collaborative Commissioning Forum (CCF) and achieving positive outcomes, demonstrate that the escalation process is effective. This will be an agenda item for the next meeting. Allison Sathiyanathan who attends the CCB, confirmed that quality issues are being raised at the meeting with the CQC in attendance. An overall action plan has been requested that deals with the quality issues

AS


Agenda Item

CCGQIC


at the Trust. Due to the significant delay in providing this action plan, the new interim chief executive has taken personal responsibility for its production. Greg Mitten explained the escalation process for quality issues within the CCG including triangulation of meetings and feedback received. Quality issues can also be escalated to the Executive Committee, Governing Body meeting and included on the risk register. Dr Rakesh Jaidka commented that the GPs’ issues sent to the Trust were not responded to with feedback of action taken. This issue is discussed under item c. West Lancashire CCG failed the IAPT Access target by 41 patients in April 2016. As this is a result of other CCGs over-performing their access targets which reduces capacity available for West Lancashire, this is a contractual issue. Further information will be sought on this issue.

b. Serious incidents monthly report (SIs)

One of the purposes of this report, produced by the CSU, is to ensure lessons are learned from reported serious incidents. They are looked at by the Serious Incident Review Group and escalated with themes identified. There were three StEIS incidents reported in May involving West Lancashire CCG patients. At 31 May, 66 StEIS incidents remain open including 35 incidents for pressure ulcers. Care homes are not reporting incidents within the required 48 hours. The CSU have been asked to produce a report for each provider for 2015-16 listing the reporting delays and reasons for extensions for completed reports, which will be brought back to the next meeting. This is highlighted by the contract monitoring team.

c. GP issues – Quarter 4 The report details 15 issues raised by GPs in quarter 4. They include issues relating to discharge information, delayed x-ray results and patient letters being sent to the wrong practices. Allison Sathiyanathan highlighted that no outcomes were included in the report, for example no information governance incidents have been raised by the Trust. The complaints process for St Helens Hospital was highlighted, where senior staff respond within hours of an issue around results being raised. Also, Lancashire Care Foundation Trust have a customer liaison officer and an effective process. At the last contract meeting with Southport and Ormskirk Hospital Trust, the GP issues report was discussed. The Trust now have a datix system in which to record GP issues, but there is no capacity to respond to GPs with the action taken in respect of the issues. Simon Featherstone, Rob Gillies and Mandy Power were actioned to ensure a process is in place to deal with GP issues. Chris Russ will be consulted in respect of practices being provided access to datix to view the outcomes to the GP issues. At the next contracting meeting, Allison Sathiyanathan will suggest the Trust contact other Trust’s to ascertain how GP complaints are manged and provide feedback to the complainants. Debbie Dobson will ask practice managers to undertake a 2 week audit to monitor the frequency of receiving incorrect x-ray results / discharge letters and will present the evidence to Allison Sathiyanathan.

JMoran

AS

AS

AS

DD


Agenda Item

CCGQIC


X-ray results sent in batches have delayed the receipt of individual results and the x-ray department are advising patients that results will be available from GPs in 5 days, when they are actually available at 2 weeks.

d. Patient Experience Group (PEG) i. Terms of reference

The terms of reference for the Patient Experience Group were presented. The group was set up 12-18 months ago with the purpose of listening to the views of the patients and public to inform the shape of the CCG priorities and promote learning. Any themes will be passed to appropriate CCG managers to investigate and escalate if required. The Quality and Safety Committee: approved the terms of reference, following one typo being made.

ii. Patient experience report

The quarterly patient experience report which provides an oversight of engagement was presented. This is an embryonic version which lists all forms of patient experience including Healthwatch visiting schemes in care homes and visits and access to hospitals. Healthwatch Lancashire also receive comments and concerns from the public which demonstrates the triangulation of Healthwatch, communication and engagement and the Quality and Safety Committee. Future Healthwatch bulletins will be circulated via the staff ebulletin. The committee were invited to comment and make suggestions on the content. The ‘Council for Voluntary Service’ will be changed to the ‘Voluntary Community and Faith Sectors’. Bob Minto informed the committee of the equality grading event taking place on 29 September and invited the committee to forward any items. Folders will be set up on Sharepoint for formal comments and soft information. There is a need to ensure that the public’s comments are addressed and action recorded. The Healthwatch reports were commended and a request for key findings from the reports was made. Sheralee Turner-Birchall confirmed that feedback was not provided by the Trust. Healthwatch will carry out an impact measurement this year, starting with care homes, with a review of the ‘enter and review’ system to ascertain how helpful it is to care homes but taking a sample of the care homes to assess improvements made.

iii. Letter of complaint

Amanda Gordon declared an interest in this item, which was deemed as fundamental and Amanda left the room for this item. A letter of complaint to the Trust was shared with the committee in line with the complainant’s request. The timeliness of the response to the complaint and the suggestion of an advocacy service was discussed. The letter will be acknowledged and, as the commissioner, the CCG will challenge the Trust as to whether an advocacy service was suggested and if the response timeline was explained to the complainant. The photos should now be deleted from emails received.


Agenda Item

CCGQIC


e. HCAI – infection control Jane Mastin provided an update on infection control. There is a national zero tolerance target for the occurrence of MRSA, and each case is investigated independently. A case of MRSA was highlighted involving a patient in a nursing home. A multi-disciplinary panel investigated the case, which was assigned to the CCG. The antibiotic for current UTI had not been reviewed and on testing the hospital concluded that the infection was immune to the current antibiotic. The root of infection was assigned to abrasion of the groin due to a fungal infection. On admittance to hospital sepsis was diagnosed. Consequently, investigation is ongoing as to why threw s a delay to the ambulance response. Any areas of poor practice will be highlighted in lessons learnt and within the action plan. An MRSA case identified in May from a sample taken in March had also been investigated. This involved a complicated path and has been assigned to a third party at Stoke Hospital. Action plans from all cases of MRSA bacteraemia are monitored by Allison Sathiyanathan and updated to the committee on a regular basis. The Trust’s level of C. Difficile infection is below the national trajectory with 1 or 2 cases identified each month. Once the infection is diagnosed the GP is consulted to look at action which may have contributed to the infection. Both community and providers should investigate every case. If the sample from a patient is positive within 48 hours of entering hospital the infection is contributable to community and after 48 hrs the Trust must investigate. The CCG are currently involved in the cases which are challenged by the Trust. It is essential that lessons are learned by the Trust from the cases attributable to the provider. Jane Mastin proposed that a panel should be convened to ensure both community and Trust cases are considered and lessons learnt. The panel would require representation from a GP, CCG, infection control and the Trust. The national guidance for C. Difficile is available around the objectives of the panel and currently West Lancashire CCG is the only Lancashire CCG without a panel. The infection control team speak to GPs about the quality issues and measures they can take to prevent C. Difficile occurrence and have a lot of experience to bring to the table. The Trust representative from infection control is available to attend the panel. As the CCG capacity is a concern, it was agreed a business case will be provided and this will be discussed at the Executive Committee.

f. Exception report The quality and performance report which features providers party to continuing healthcare, nursing home and independent sector mental health was presented. Any comments on the report should be passed to Allison Sathiyanathan for Claire Heneghan. Discussion ensued about what happens next from the action taken. Sheralee Turner-Birchall advised that from the RADAR meetings, a list of homes post-QIP are received and a number will be revisited by the local authority.

g. Child Death Overview Panel (CDOP) annual report 2014-15 The annual report provides trends in child deaths reviewed during the last reporting year and all deaths, data analysis reviewed since April 2018. This is the seventh annual report since the CDOP became statutory. The

AS/ JMastin


Agenda Item

CCGQIC


following key points were highlighted: • 24% of deaths were identified to have modifiable factors including

alcohol/substance misuse and smoking in parents/carers etc. • Recommendations to pan-Lancashire LSCB to determine a revenue

stream amongst partners to continue with safer sleep programme. To remind professionals to ensure CDOP forms are completed in full. Partners across child health and wellbeing should assure themselves that co-ordinated strategies to address the determinants of health in line with the Marmot principles. Chairs to identify and marketing representative for the SUDC Prevention Group.

In response to the modifiable factors, Greg Mitten confirmed that the CCG has focussed on health equalities and disproportionate issues with partners. The CCG is looking at a county initiative around infant mortality, recognising low resources and the prevalence of alcohol drugs etc. Concern was raised about the pressure on services in terms of working in a partnership way. A question was raised about a business case for the CCG. Louise Burton will feedback to the CDOP via the LSCB and continue to provide updates on the content of the report. The Quality and Safety Committee: noted the report.

h. Safeguarding Activity Report The CCG has been included in the second cohort of NHS England safeguarding assurance visits to review the CCG’s safeguarding arrangements and ensure consistency in Lancashire. The CCG will be required to demonstrate compliance with the safeguarding accountability and assurance framework and wider objectives, outlined by the framework. An action plan will be provided at the next reporting period.

A pan-Lancashire safeguarding assurance framework group has been developed in order to work collaboratively to streamline the annual safeguarding standards assurance process.

A proposal has been agreed to introduce a county wide multi-agency panel which will provide consistency and improved governance to Radar and QIP processes. There is one red rated area pertaining to there being no contractual and quality assurance arrangements in place for domiciliary health provider services commissioned by the CCG. Safeguarding themes in relation to poor quality care have raised significant issues in respect to a lack of contractual and quality assurance arrangements. This is reported to be a Lancashire CCG wide problem. A paper has been prepared for the CCF. Lorraine Elliott will keep the committee informed.

The CCG have been shortlisted in the education and training category within the National Patient Safety Awards and the Transforming Care awards. The development of this work is an example of the excellent collaboration in place across the safeguarding partnership and a chance to showcase the work nationally.

Dr Rakesh Jaidka left the meeting.

i. CCG Accountability and Assurance Framework

LE


Agenda Item

CCGQIC


An action plan was provided to address areas for improvement to ensure the CCG is compliant against the CCG’s self-assessment for the Accountability and Assurance Framework for safeguarding (Vulnerable People in the NHS 2015) and section 11 Children Act 2004. The self-assessment for the CCG came to the previous meeting and the areas of actions have been clearly identified. The actions within the plan include: safeguarding responsibilities need to be in staff job descriptions; development of a more robust framework for engagement with CYP and families/carers; staff with contact with children and young people undertake CSE e-learning training; and identification of a GP with additional safeguarding responsibilities is required. The Quality and Safety Committee: noted the report. Lorraine Elliott left the meeting.

j. NHS England Safeguarding Assurance Audit The Designated Lead Nurses have met with the regional leads from NHS England to provide CCG compliance against the NHS England Accountability and Assurance Framework. Key areas for improvement have been identified, some of which have already been identified in the CCG’s self-assessment. Additional areas are highlighted below: • The CCG has been rated red for compliance against operating manual

requirements relating to Special Educational Needs and Disabilities (SEND). The Executive Committee is aware of the rating.

• Safeguarding training needs analysis is to be developed • Safeguarding statement is required in the complaints and whistle

blowing policy; it was acknowledged that a safeguarding statement has been included in the recently revised complaints policy.

• Safeguarding leads are required to compile and circulate information within the CCG in respect of professional boundaries

A combined action plan will be produced for the CCG and return to future meetings.

k. HODs pathology The Trust haematology check are undertaken by the Royal Liverpool Hospital and take 3-4 weeks to receive results, whereas Whiston Hospital results only take 7 days. Paul Mansour is undertaking an audit to identify the impact on patients due to the additional wait. When the outcome of the audit is available, discussion with the Trust in terms of contracting will take place.

06/16/6 Governance and Performance a. Corporate risk register

Debbie Dobson left the meeting and committee was no longer quorate. The corporate risk register was presented for information or greater interest. Some risks require more attention for example, changes requested in the safeguarding team had not been made by the CSU. The group agreed that Allison Sathiyanathan speak to Paul Kingan about this issue. Allison Sathiyanathan will raise two possible new risks: CQUIN for edischarge and mandatory training.

b. Complaints and issue policy and procedures

AS


Agenda Item

CCGQIC


This item was brought forward to ensure quoracy of the committee. The policy had been previewed, amended and returned to the committee for approval. It cannot be issued until the other related policies highlighted within the document are updated. The Quality and Safety Committee: Approved the policy

06/16/7 Any other business The minutes from the following meetings show the depth of the discussion on quality and were noted: Southport and Ormskirk Collaborative Commissioning Forum – April 2016 Southport and Ormskirk and Clinical Quality Review – March and April 2016 Louise Burton reported that CQC inspection review of services for safeguarding and looked after children in Lancashire took place week commencing 6 June the CCG was notified on the 2 June. Feedback has been provided to CQC regarding process; some comments related to not all CCGs and providers being notified, challenges with complexity of provider footprint, high level briefings were seen as positive and positive response by providers and CCGs. General themes which were cross cutting and related to several services included: Good practice:

• In some areas: there were good engagement with child protection and child in need work, case work demonstrated good involvement with children and families ‘Think Family’ well embedded, children on child protection plans clearly flagged and pro-active, responsive and visible service

• Positive and co-ordinated approaches to identification of risk to children and young people and their families

• Lots of child and young person focussed practice • Evidence of appropriate and good standard referrals to Children’s social

care including good analysis of risk. Areas for improvement:

• Commissioning arrangements for the 16-18 population needs urgent attention for all services and transition arrangements from child to adult services needs to be seamless,

• Ensure staff are trained to the appropriate levels as determined in the intercollegiate document’ s

• Perinatal mental health pathway’s need to be in place and operational • Improved Interface between all services including Adult Mental Health,

Substance misuse, HV’s SN’s, Midwives, GP’s community and acute services in some areas

• Routine enquiry for Domestic Abuse, FGM, CSE inclusive of risk assessment tools and processes.

• To review supervision models to ensure they are fit for purpose • Record keeping in line with expected professional standards

Next steps were discussed in terms of responding to the draft CQC report, anticipated end of July and co-ordinating the response within 5 days.

Date and time of the next meeting –


Agenda Item

CCGQIC


Tuesday 26 July at 1.30 pm, Boardroom, Hilldale

Page 1 of 3 West Lancashire Clinical Commissioning Group Audit Committee – 24 May 2016

Minutes DRAFT

Meeting Title: West Lancashire Clinical Commissioning Group Audit Committee

Date: 24 May 2016

Time: 9.00 – 10.00 am Venue: The Artz Centre, Hartland, Birch Green, Skelmersdale, WN8 6QE

Present: Douglas Soper, Lay Member (Chair) Greg Mitten, Lay Member Dr Jack Kinsey, GP Executive Lead In attendance Paul Kingan, Chief Finance Officer Paul Jones, Head of Finance Tommy Rooney, External Audit (Grant Thornton) Dr Rakesh Jaidka, GP Executive Lead Dr Vikul Mittal, GP Executive Lead Cathy Ashcroft, Executive Assistant

Apologies: Claire Heneghan, Chief Nurse Dr Bapi Biswas, GP Executive Lead Dr Adam Robinson, Secondary Care Doctor Fiona Blatcher, Associate Director, External Audit (Grant Thornton) (in attendance)

Agenda

Item Summary of Discussion Action

1. Welcome, Introductions and apologies for absence Doug Soper welcomed all present to the meeting of the Audit Committee. Apologies were noted as above. The two new elected GP Executive Leads, Dr Rakesh Jaidka and Dr Vikul Mittal, attended the meeting as observers and introductions were made.

2. Declarations of interests No declarations of interests pertinent to agenda items were raised.

3. External Audit Audit findings report for the annual accounts Tommy Rooney from Grant Thornton presented the audit findings report for the annual accounts, which provided a unqualified opinion on the audit of the accounts and value for money. No significant issues had been identified in the annual accounts. The annual governance statement and annual report continues to be checked and possible minor changes could be made. The audit report will be signed on confirmation that there are no post account events. Further to the presentation of the external auditors plan at the audit committee in April, no additional risks have been identified and no changes have been made to the materiality level for the CCG. An initial risk assessment of Value for Money (VFM) identified three risks: Financial outturn and sustainability; Better care fund; and CQC inspection of main acute provider. The external auditors were satisfied that sufficient measures are in place to address the risks with no issues arising. Thanks was given from external audit and the audit committee to Paul Jones and his team (Sara Daulby, Al Hewitt, Adelle Halksworth and Janet Kearton) for their co-operation in completing the audit and producing the annual accounts and annual report.


Management representation letter The representation letter requested by the external auditors is the standard letter requested from NHS bodies. The letter essentially gives confirmation that the CCG governing body members have fulfilled their responsibilities around preparation of the accounts in accordance with International Financial Reporting Standards and accounting policies directed by the NHS Commissioning Board. On approval, the letter will be signed by the vice-chair, in the absence of the chair, and chief officer on behalf of the CCG governing body. The audit committee: noted the audit findings report for the annual accounts and recommended the management representation letter be submitted as requested. The audit committee recommends to the governing body, the authorisation of the management representation letter by the vice-chair and chief officer.

4. Annual report Paul Kingan presented the pre-design stage annual report and circulated a copy of the designed annual report. The changes to this year’s annual report were highlighted as follows: • The list of attendances at the membership council highlights the principal

GP for each practice. • Section 28 demonstrates how the quality agenda has been strengthened

with community stakeholders / partners. • In March the governing body agreed to reduce the scoring threshold from

15 to 12 for the risks which are included in the board assurance framework.

• The programme of work for internal audit has been achieved with all audits receiving significant assurance.

The report includes a summary of what the CCG has achieved during the year as compiled by Meg Pugh and Sara Daulby. External audit have checked the content including the remuneration and pensions, with a final check to be undertaken of the published annual report. Praise was given to Meg Pugh, Sara Daulby and Janet Kearton for their work on the annual report, which will be posted on the CCG website in June 2016 and presented at the annual general meeting in September 2016. The report includes financial statements of which the four primary statements consist of: Comprehensive net expenditure; financial position; changes in taxpayers’ equity; and cash flow. Employee costs and staff numbers have increased due to transferring services in-house from the commissioning support unit. This change had provided further control of the services and a financial benefit. CCG staff sickness levels had decreased from the previous year. The committee commended the annual report. Annual Governance Statement The annual governance statement details the governance arrangements outlining how the organisation manages risk to the quality agenda and details the audits carried out in this year, all of which have received significant assurance.


The audit committee: Recommended the annual governance statement and annual report be approved by the governing body. The annual report and accounts will be signed by the chief officer following the governing body meeting today. Financial statements Doug Soper thanked those involved for their hard work in producing the annual report and accounts including Meg Pugh, Paul Jones and Sara Daulby, Adelle Halksworth, Al Hewitt and Janet Kearton. The audit committee: Recommended the annual accounts be approved by the governing body.

5. Governing body recommendation Further to noting the external auditors findings, the audit committee recommend the following to the governing body: • the management representation letter be signed by the chief officer and

vice-chair, in the absence of the chair. • the annual report, annual governance statement and accounts be

approved by the governing body. • the annual report and accounts be signed by the chief officer following the

governing body meeting today.

ANY OTHER BUSINESS 6. Date and time of next meetings

Tuesday 13 September, 1.30 – 3 pm, in the Boardroom, Hilldale.

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West Lancashire CCG Clinical Executive Committee Action and Notes – 31/05/16

Discussion and Decisions This week’s actions Due Date

Responsible officer

RAG

Attendees Mike Maguire – Chair John Caine – CCG Chair Jackie Moran – Head of Quality Performance & Contracting Debbie Dobson - Practice Manager Doug Soper – Lay member Jo DeBacker – Practice Manager Anne-Marie Bridge – Admin Officer Adam Robinson - Secondary Care Consultant Vikul Mittal - GP Executive Lead

Apologies Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Greg Mitten - Lay Member Paul Kingan – Chief Finance Officer Claire Heneghan – Chief Nurse Bapi Biswas – GP Executive Lead

Declaration of Interest

None.

Notes from previous meeting

The notes were approved subject to the amendments noted below.

Strategic and service redesign

Item 3 – Lancashire Primary Care Proposal Grahame Urwin from NHS England had approached Mike with the Lancashire Primary Care Proposal presented by Ernst & Young with a view to West Lancashire being

Discuss further with NHS England Add to membership

Mike & John

1



Responsible officer

RAG

Attendees John Caine – Chair Mike Maguire – Chief Officer Paul Kingan – Chief Finance Officer Jackie Moran – Head of Quality Performance & Contracting Bapi Biswas – GP Executive Lead Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Vikul Mittal - GP Executive Lead Jack Kinsey - GP Executive Lead Debbie Dobson - Practice Manager Jo DeBacker – Practice Manager Adam Robinson - Secondary Care Consultant Doug Soper – Lay member Greg Mitten - Lay Member Stephanie Tabron – Admin

Apologies Claire Heneghan – Chief Nurse


None

Headline Items for AOB

Quality Committee – Greg Mitten


Item 3: Lancashire Primary Care Proposal – It was clarified that the meeting referred to in the previous minutes about the Lancashire Primary Care proposal, is to be held with EY and NHS England on the afternoon of Tuesday 7th June.

Amend previous meeting’s notes

14/6/2016 Mike Maguire

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West Lancashire CCG Single Item Clinical Executive Committee Action and Notes – 14/06/16


Responsible officer

RAG

Attendees In attendance

John Caine - CCG Chair Bapi Biswas – GP Executive Lead Debbie Dobson - Practice Manager Doug Soper – Lay member Greg Mitten - Lay Member Jack Kinsey - GP Executive Lead Jackie Moran –Head of Quality Performance & Contracting Jo DeBacker – Practice Manager Joanne Kane – Admin Officer Mike Maguire – Chief Officer Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Vikul Mittal - GP Executive Lead Amanda Gordon – Service Redesign Manager

Apologies Adam Robinson - Secondary Care Consultant Claire Heneghan – Chief Nurse Paul Kingan – Chief Finance Officer


Bapi Biswas, John Caine and Peter Gregory declared an interest in the MSK single item.


The notes were approved subject to the amendments noted below. Item 4 MSK Update It was noted that individuals had been attributed as voicing concerns however the comments should have been noted

1



Responsible officer

RAG

Attendees John Caine – Chair Mike Maguire – Chief Officer Jackie Moran – Head of Quality Performance & Contracting Doug Soper – Lay member Anne-Marie Bridge – Admin Officer Adam Robinson - Secondary Care Consultant Vikul Mittal - GP Executive Lead Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Paul Kingan – Chief Finance Officer

Apologies Greg Mitten - Lay Member Claire Heneghan – Chief Nurse Bapi Biswas – GP Executive Lead Debbie Dobson - Practice Manager Jo DeBacker – Practice Manager


Drs Gregory, Jaidka and Mittal declared an interest in the future hosting of Respiratory Services.

Roles and Responsibilities

Agreed and noted.

1



Responsible officer

RAG

Attendees In attendance

John Caine - CCG Chair Adam Robinson - Secondary Care Consultant Bapi Biswas – GP Executive Lead Claire Heneghan – Chief Nurse Doug Soper – Lay member Jack Kinsey - GP Executive Lead Jackie Moran –Head of Quality Performance & Contracting Jo DeBacker – Practice Manager Joanne Kane – Admin Officer Mike Maguire – Chief Officer Paul Kingan – Chief Finance Officer Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Vikul Mittal - GP Executive Lead Kathryn Kavanagh - Lead Manager Health Inequalities Lucinda McArthur - Senior Operating Officer Karen Tordoff – Lead Manager Service Redesign

Apologies Debbie Dobson - Practice Manager Greg Mitten - Lay Member


All GP members declared an interest in item 10 – Moving forward with 7 day access.


Item 3 - Well Skem Lucinda and Kathryn attended to present slides to update the Exec committee on progress in the Well Skem project. Lucinda began with changes in leadership following the

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unexpected death of Professor Aidan Halligan. After a pause in the programme and a stocktake exercise the lead for Well North is now Andrew Mawson. Three short films were shown which convey the ethos behind the project and the achievements seen in the Bromley by Area, which members of the Exec and other CCG staff had visited early this year. This was followed by a residential session and health immersion event. The focus in Skem will be on the following aspects;

Education

Enterprise

Environment

Regeneration opportunities

Beautifying the place

Respiratory health

Social prescribing

GP workshop from Dr Sam Everington

Adopting the Bromley by Bow learning

Discussion followed on the project including how to increase GP involvement. It was noted that the Well Skem ethos is congruent with the aims of the Community Procurement programme. Each bidder for the Community service will be expected to set out how they would involve voluntary groups and make best use of the third sector. There was also discussion on how to measure progress without detracting from the person centred ethos. There is another event taking place on the 15 July where the Well North team will look at each theme described above and plan next steps.

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Item 4 – Alliance STP feedback Mike outlined the current proposal as it stands now. It was noted that due to the geography of WLCCG there are three potential STP plans that can affect the area. The Exec committee will be informed of progress as the plans continue to be shaped. At present there is no need for any decision from the Exec Committee regarding this plan; however there was broad agreement in the Exec committee that WLCCG remains focussed on improving out of hospital provision in order to keep patients care in the community where appropriate.

Operational Item 5 – Ambulance Performance John Caine presented a paper setting out Ambulance performance including details such as response times, turnaround times and what has impacted performance. There followed discussion on the Trust’s and NWAS performance and how breaches in performance are managed by CCGs. There is also an issue with workforce recruitment and retainment. This is a big issue and it is acknowldeged that there is need for system wide improvement. Item 6 - Well Being Service Karen Tordoff presented to give a verbal update regarding integrated wellness. This service has been in place since 1 April, Karen met with the service recently where they reported a substantial increase in referrals. It was suggested that further involvement from this team into MDTs would be beneficial, as would better comms around this and similar services.

E-meeting

Item 7 - Notes from previous meeting The notes from the development session were approved.

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Item 8 - Process for managing IFR The Exec committee discussed any changes from the previous policy, the paper was approved but will go to the Governing Boad for formal ratification. It was suggested that the new exec members could be invited to a future panel to experience first hand how IFR process works. Item 9 – Membership agenda It was noted from the e-meeting comments that Medicines Management need to include an item and the informal federation should take place after the membership meeting has finished. The agenda will be amended accordingly.

Hot topic Item 10 – Moving forward with 7 day access All GP members declared an interest in this item. John Caine stood down as chair and the chair was passed to Mike Maguire. The chair decided that the interest was significant but not fundamental and that no vote would be required. All GP members were therefore allowed to take part in the discussion. A brief update was given on initial thinking to achieve 7 day access, it was noted that a business plan will be submitted for approval to the Governing Body in due course. Discussion followed on the crucial aspect of information sharing in increased access and the logistics delivering increased access then took place. Progress will continue to be relayed to the Exec Committee as this moves forward.

Wrap up

2

Strategic and sevice redesign

Item 5 – Annual Seasonal Influenza Vaccination Uptake 2015/16 WLCCG – Update from Tricia Spedding Public Health Commissioning Manager, NHS England North (Lancashire) and Christine Khiroya, Screening and Immunisation Nurse Consultant, Lancashire, Public Health England NHSE North provided an overview of the WLCCG seasonal influenza vaccination programme 2015-16. WLCCG supports the development of a local ‘flu group and partnership working across West Lancashire. This will ensure all aspects of this ‘flu vaccination programme are commissioned and delivered to meet population needs. A WLCCG ‘flu lead is to be appointed. Members of the Committee raised several questions to which NHSE will feedback on.

Identify a WLCCG lead 28.06.16

All

Item 6 – Ophthalmology Tier 2 Service The Committee was provided with an update on this with a view to looking at how WLCCG will move forward Ophthalmology Tier 2 Service 2016/2017 The Committee took a vote and agreed that 2 WLCCG Committee members will work on this process. The Committee also took a vote and agreed the current service is to continue for a further 6 months.

Drs Jaidka and Gregory will work together to look at the process. Dr Jaidka will be the WLCCG lead for this.

28.06.16 Drs Jaidka and Gregory

Item 7 – Temporary Hosting of Respiratory Service As Drs Gregory, Jaidka and Mittal declared an interest in the future hosting of Respiratory Services earlier in the meeting, they left the room whilst the item was discussed.

Focus group to be set up to discuss the Temporary Hosting of Respiratory Service and delivery of.

28.06.16 Dr Kinsey, Carol McCabrey and Doug Soper

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The Committee agreed that three committee members would form a focus group to work together and form an interview panel ahead of receiving bids to manage the temporary Hosting of Respiratory Service.

Item 8 – SEND (Special Educational Needs and Disabilities) Joint Commissioning The Committee was updated on the Framework Agreement for Learning Disability Supported Living Services – Transforming Care. This is a Pan-Lancashire project and Lancashire County Council (LCC) will be leading on this Framework Agreement. WLCCG have been working closely in partnership with the Lancashire CCGs which will to develop this framework. The Committee recongnised the need to have a WLCCG lead for this project.

Identify a WLCCG lead for SEND

28.06.16 Carol McCabrey

Operational

Item 9 – Feedback from CQC Safeguarding Carol McCabrey updated the Committee on a CQC inspection that took place in June, prior to the CQC report comes out in July. No action is required.

Item 10 – Reflection from Membership Meeting MSK – The Committee was advised that Membership received a presentation regarding MSK. No action is required. Primary Care at Scale – The Committee discussed

Meeting to be set up with Dr Jaidka and Ernst and Young Federation to be invited to the Development Session on 28 June 2016

28.06.16 28.06.16

Dr Jaidka Mike Maguire

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Primary Care at Scale and it was agreed this would be reviewed at the next Committee Development Session.

Item 11 – Reflections from S&O Contract Meeting This item will be adjourned to the next Executive Committee meeting.

Headlines for AOB - LCC Procurement Framework for Transforming Care The Procurement Framework for Transforming Care was presented to the Committee. A vote was taken by the Committee and it was agreed that WLCCG will become affiliated with it.

Item 12 - Notes from Previous Meeting The notes from the previous meeting were agreed as a correct record.

Item 13 – Notes from Medicines Management Meeting 12 April 2016 These were noted by the Committee.

28 June 2016 – Board Development Session

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as raising a query and not as voicing concerns. The minutes should have stated that “Doug Soper asked if GPs had managed to contact the provider in Newcastle in preparation for the June Membership. GPs had said this had not proved possible.” In addition the paragraph which stated “concern was expressed that…” should have stated “Given that compromise had to be made with aspects of the model to maintain collaborative working and some of the more ambitious QIPP savings were now not proposed for delivery in the short term, what impact would this have on QIPP delivery and what schemes may be put in place to deliver the necessary QIPP? Executives agreed to consider further other options for QIPP savings from Orthopaedics in the short term.”


Item 3 – MSK Presentation to Membership – achieving the QIPP savings Bapi Biswas, John Caine and Peter Gregory declared an interest in this item as they provide joint injection in practice. The chair passed to Mike Maguire who decided that the interest was significant and not fundamental. Bapi Biswas, John Caine and Peter Gregory were therefore allowed to take part in discussion; no vote was required for this item. The chair was passed back to John Caine. Peter presented slides that were to be taken to the Membership Council on 15 June. Amanda Gordon was thanked for preparing the presentation. The Exec Committee was asked to consider the information and provide feedback. It was noted that the current MCAS/MSK service provision

3

does not give value for money or satisfactory patient outcomes and as such WLCCG had undertaken to address the issue via service redesign. There followed a detailed discussion on how best to present information to the Membership Council so as to facilitate a wide discussion and a clear understanding of what is being proposed. It was suggested that the following be included; some background in regard to patient reported outcome measures (Oxford measures), the aims and objectives of the redesign. It was noted that for GPs to be on board with the re-design the benefits of the proposed new model should be clear. As yet the delivery of the proposed model isn’t signed off by the Trust so Membership would be given information as to WLCCGs options in the event of the Trust declining to sign up. This could mean making a decision on going to procurement, if deemed necessary this would now be done in conjunction with S&FCCG.

Any Other Business A brief update was given on both the S&O interim management arrangements and the risk summit held recently. The Exec committee will continue to be informed of developments.

Wrap up

2

Strategic and Service Redesign

Item 4. MSK Update

Membership Presentation Next week’s Exec. Committee meeting will be a single item agenda.

Discussion with Southport & Formby CCG Following the Board Development day, Dr Peter Gregory updated the Executive on progress with achieving the MSK orthopaedic savings. Doug Soper expressed his concern that the GP leads had not visited the private provider in Newcastle before the June membership meeting as they had agreed to do. Concern was expressed that following the steer from the clinical lead to try to compromise on aspects of the model to keep S and F CCG on board, there was now no clarity on how the required QIPP savings would be achieved. Dr Gregory suggested that a member of the CCG redesign staff be allocated to the Trust to undertake their redesign. This was not agreed to. Dr Gregory was requested to work up a presentation for membership that gave a clear indication of how the savings could be achieved, and to ask the membership whether it wanted to go alone on a procurement with the original model or to work to the S and F agenda and

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timescale. Dr Gregory to bring and go through the draft presentation for the June membership at exec on 14th June to give the required level of clarity and achieve membership buy in. Item 5. JOG Presentation Slides were presented looking the S&O Trust’s Sustainability and Productivity update. No decisions were required at this time. Suggestion to set up a ‘JOG Forum’ to keep the meeting refreshed and up to date. Item 6. Guidelines for the Management of Headache in Primary Care Following a Neurology Pathways GP Meeting a discussion was held and it was agreed that WLCCG will engage with this meeting.

Prepare presentation Engage with Neurology Pathways GP Meeting

14/6/2016 14/6/2016

Peter Gregory Jackie Moran

Operational Item 7: Risk Summit follow-up – Southport A&E The meeting was updated regarding the discussions about the request from the Trust for the CCGs to provide funding for changes to help A and E flow. Mike and Paul had relayed the information that the CCG did not have the money to do this and that this would need to covered within existing PBR income. Southport and Formby CCG had expressed a similar opinion.

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Kim Hodgson was planning to contact NHSE to request another risk summit as no decision had been made Item 8. Draft Membership Agenda Draft Membership Agenda was amended accordingly.

Provide update on Membership meeting

14/06/2016

Dr Jaidka

Exec E-Meeting Item 9. Notes from Previous Meeting

Moved to start of meeting notes Item 10. Equality and Diversity

To be deferred to next Exec. Committee Meeting Item 11. Collaborative Commissioning Agreement – Medequip

Paul to feedback update after the next meeting

Provide Update

14/06/2016

Paul Kingan

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funded by NHSE to be the pilot site for Lancashire. Mike and John had agreed that West Lancashire would be interested in being the pilot site. The committee was asked for their comments about how the CCG should approach this initiative. Discussions took place about potential options including a locality approach with Skelmersdale practices going first or like minded practices or a whole CCG approach. Mike and John are to meet with NHS England again next week and would raise any issues from today’s meeting. It was decided that the CCG should progress the proposal as it was being funded by NHSE and the potential options to implement this would be discussed at the next membership meeting.

agenda

Item 4 – Any Other Business Southport and Ormskirk performance and quality risk relating to A&E Following from the Risk Summit Meeting Southport & Ormskirk NHS Trust have asked West Lancashire CCG and Southport & Formby CCG for extra funding to help relieve the pressures on A&E and help to implement a new patient flow. It was agreed that the suggestions to improve patient flow would help, this would create a recurrent financial pressure that the CCG could not afford and would lead to financial targets being breached. The decision reached was to not award additional funding but a solution needed to be found that was covered by existing PBR funding.

Wrap up

S&O System Resilience Group (SRG) UNRATIFIED MINUTES

Date: Wednesday 15th June 2016, 0930 hrs to 1100 hrs Venue: Almond Room, Family Life Centre, Ash Street, Southport, PR8 6JH Attendees Fiona Taylor (CHAIR) Chief Officer, Southport & Formby CCG FLT Dr John Caine Chair, West Lancashire CCG JC Tracey Cook-Scowen Deputy Clinical Director - Adult Community Services, Lancashire Care NHS Foundation Trust TC-S Debbie Curran General Manager, Community & Continued Care DC Billie Dodd Head of CCG Development, Southport & Formby CCG BD Trevor Hubbard Assistant Director of Operations – Interim, Southport & Ormskirk Hospitals NHS Trust THu Mike Maguire Chief Officer, West Lancashire CCG MM Patrick Johnson Interim Chief Operating Officer, Southport & Ormskirk Hospitals NHS Trust LH Charlotte McAllister Urgent Care Commissioning Lead, West Lancashire CCG CMcA Clare Mattinson Manager - Policy, Commissioning and Business Information – Age Well, Lancs CC CM Mark Sergeant Acting Clinical Services Manager, Assessment Services, Mersey Care NHS Trust MS Yvonne Taylor Patient Flow Matron, Southport & Ormskirk Hospitals NHS Trust YT Mark Waterhouse Head Social Worker, Sefton Council MW In Attendance Lyn Cooke Head of Communications, Southport & Formby CCG LC Liz Melia Commissioning Lead, Quality Improvement, MLCSU LM Nicky Ambrose-Miney Acting Head of Assurance & Delivery NA-M Andrew Watkinson Information Team, Southport & Ormskirk Hospitals NHS Trust AW Apologies John Betteridge Sector Manager – North, Cheshire & Merseyside Area, NWAS JB Jeanette Abraham Assistant Director of Operations Planned Care, Southport & Ormskirk Hospitals NHS Trust JA Kate Burgess Commissioning Manager, Lancashire County Council KB Dr Rob Caudwell Chair, Southport & Formby CCG RC Simon Featherstone Director of Nursing & Quality, Southport & Ormskirk Hospitals NHS Trust SFe Penny Fell Chief Operating Officer, New Directions PF Christine Fisher Mersey Care NHS Trust CF Sharon Forrester Cardiovascular Disease Programme Lead, Southport & Formby CCG SFo Claire Heneghan Chief Nurse, West Lancashire CCG CH Karl McCluskey Chief Strategy & Outcomes Officer CCG KMcC Debbie Mallett Service Development Manager, Cheshire & Merseyside, NWAS DM Joanna Stark Assoc Director of Operations - Women’s & Children’s Services and Community & Cont Care JS Michell Walling Directorate Manager, Community & Cont Care, Southport & Ormskirk Hospitals NHS Trust MWal Tina Wilkins Head of Service, Vulnerable People, Sefton Council TW

NO ITEM ACTION SRG16/43 Welcome, Introductions & Apologies

Apologies were received from John Betteridge, Jeanette Abraham, Kate Burgess, Dr Rob Caudwell, Simon Featherstone, Penny Fell, Christine Fisher, Sharon Forrester, Claire Heneghan, Karl McCluskey, Debbie Mallett, Joanna Stark, Michell Walling and Tina Wilkins.

SRG16/44 Notes and Actions from Previous Meeting The notes were accepted as a true and accurate record. Actions SRG15/44 Any Other Business - Flu Resilience - exercise sygnus – completed, plan requires updating in the Trust. Antiviral national plan not yet available. The Trust needs to be confident plans are robust, with an HR element and all parties happy with the plan. July SRG - all organisations to assure all plans on the go and update on progress SRG16/25 NWAS Ambulance turnaround performance - update on times from 45 to 35 minutes - to be on dashboard in future and on agenda so progress can be discussed at each meeting. Ambulance Handover Follow Up Event on 7th July – NA-M to send details to JBy for onward circulation to members [post meeting note: see attached email from NHSI for detail].

ALL

AW/JBy

NA-M/By

NO ITEM ACTION

SRG16/26 Trajectory for recovery of A&E target - Looking to provide mental health room at S&O and additional requirements to support this. CMcA and THu discussed Interfaces between mental health providers. Re-starting meetings and connection with Angela Kelly. Yet to meet with Mersey Care (Mark Sergeant). Also meeting Phil Winnard to get triangulation in place. Leave on tracker – how will it make a difference to outcomes? SRG16/28 Pressures on RTT (Referral to Treatment) - Now in dashboard and still doing some work in CCG through planned care. Numbers will be based on the constitutional standard only. There is an SRG responsibility to make sure RTT is on track; the STF is a commissioner responsibility not an SRG responsibility. Remove from tracker as we will be monitoring through performance. SRG16/32 Easter plan – debrief - no unusual themes. THu commented it was the days after Easter that were more problematic, although extra resource was on hand to deal with it. Remove from tracker. Bear in mind Christmas is on similar days also. SRG16/39 Performance dashboard & capacity & demand – 1, 2 and 3 A&E – SF/THu to review referral flow from primary care; holiday leave planning (following bank holiday), leave on tracker. SRG16/39 – Paediatrics – A group has been developed to investigate A&E data to identify the cause of flow changes. Also looking at Walk In Centres and Alder Hey. Add to next month’s agenda. SRG16/39 – 10 DTOCs – AW to check DTOC reporting against NHSE definition and include 62-day cancer wait, done remove from tracker. SRG16/40 – AQuA and Whole System Flow – Another session is scheduled for 5th July on AQuA system flow session to publicise further, click here for event information/ registration details. Meeting to be arranged the following week (12th July). 16/41 Workshop Planning - MM to circulate presentation, done remove from tracker.

SF/Thu

JBy

BD

SRG16/45 Performance dashboard and capacity and demand Four-hour compliance – Thu confirmed the trajectory was expected to be 90% until September. AW to add trajectory to dashboard. Dr Caine asked if this trajectory included the 3% boost for the health centre which would have been included in February figures. AW to check. Skelmersdale Walk-In Centre – attendances slightly down on previous years. West Lancs Health Partnership – step change increase, measurement change and at this time there is no negative impact in the system. Non-Elective Admissions for Southport – attendances are going down but those people that are attending are being admitted. Re-admissions data is interesting and needs to be reviewed. Length of stay is also having an impact. DTOC – now clear that we are using the agreed definition – days delay not patients – is that something that needs to be understood at the operational level? Would a deep dive be useful? BD to get right people in room to have conversation and report back to July meeting. Referral To Treatment – lines 14 and 15 are for information only and are for discussion between commissioner/provider. Over 75s Data – Southport & Formby - LG had looked at the impact over 75s were having on the system. Over a third of all emergency admissions are from patients aged 75+ and were staying longer, on average over 4 days. Over 50% are being admitted. Overall a small percentage of patients were causing a lot of activity. LG had also looked at NWAS data - conveyances and looking at those care homes there were some discrepancies - some 2 admissions for every bed. CMcA – West Lancs - last year admissions went down but length of stay went up. Mark Waterhouse – there’s a piece of work around CQC and he believed there is fear around safeguarding issues. LG was also analysing care homes in telehealth project. It looked as though there were higher conveyances, but the system had only been installed properly in February so it was too early to tell. He believed there was a 40% reduction in NWAS conveyances in care homes were telemedicine had been introduced. Care homes were run as private businesses; there was minimum training and it was the SRG’s

AW AW

BD

https://www.aquanw.nhs.uk/events/improving-whole-system-patient-flow/21597

https://www.aquanw.nhs.uk/events/improving-whole-system-patient-flow/21597

NO ITEM ACTION

responsibility to help improve that. SRG operational team to discuss and bring back to SRG meeting. BD will bring right people together to have focus on care homes, SRG members to nominate people to be in that discussion. Mark Waterhouse informed SRG members about a Sefton resident who had presented 37 times with a blocked catheter tube, but there was a delay in CHC reassessment – FLT to ask Debbie Fagan, Chief Nurse, to investigate. Urgent Care Programme Update - THu reported a lead had now been identified. The Trust had achieved 90% trajectory over the last 3 months. They had agreed some outcome measures and opened an ambulatory care unit (formerly GPAU). There were still some issues around ambulance bookings which were being investigated. H Ward moved to A Ward which has increased bed capacity by 2 for rehab beds. A&E conversion rate most of the time hitting 35%. Yvonne Taylor leading on length of stay project. FLT/MM confirmed it was a really helpful dashboard. Kim Hodgson was in dialogue with Ian McInnes (NHS Improvement) to see what other support was available, as funding was not available from CCGs at this time due to the financial situation. GP Call Out Line - THu explained there was a problem with the GP call out line which they were reviewing and would report back on. He was also having a weekly meeting to iron out any communication problems and asked for anyone with problems to contact him.

BD

BD

FLT

SRG16/46 Whole System Escalation KH had expressed some concern about the system escalation policy – in particular interface issues in relation to NWAS, the on call system in relation to CCGs Category 2 responders. FLT to write to KH to ask what the escalation issues for S&O are. Jim Deacon doing some co-ordination as internal escalation processes have not been followed and junior members of staff are calling NHS England.

FLT

SRG16/47 Update from EMS (Escalation Management Systems) LM to meet with Acute and Yvonne Taylor w/c 23rd June. Super user training has been set up. Also met with Debbie Curran in relation to community services and are looking at setting up community bed grids. LM to chase up the contact across Lancashire Care (TC-S). Also talking to North and Mid-Mersey.

LM

SRG16/48 Any Other Business None.

SRG16/49 Date of Next Meeting Wednesday 20th July 2016, 0930 to 1130 hrs, Family Life Centre, Ash Street, Southport, PR8 6JH

ALL

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Lancashire Health and Wellbeing Board Minutes of the Meeting held on Thursday, 28th April, 2016 at 2.00 pm in Cabinet Room 'D' - The Henry Bolingbroke Room, County Hall, Preston Present: Chair County Councillor Jennifer Mein, Leader of the County Council Committee Members County Councillor Azhar Ali, Cabinet Member for Health And Wellbeing (LCC) County Councillor Matthew Tomlinson, Cabinet Member for Children, Young People and Schools (LCC) Dr Sakthi Karunanithi, Director of Public Health, Public Health Lancashire Louise Taylor, Corporate Director Operations and Delivery (LCC) Tony Pounder, Director of Adult Services Councillor Bridget Hilton, Central Lancashire District Councils Karen Partington, Chief Executive of Lancashire Teaching Hospitals Foundation Trust Dr Tony Naughton, Fylde & Wyre CCG Dr Alex Gaw, Lancashire North Clinical Commissioning Group (CCG) Dr Dinesh Patel, Greater Preston CCG Sarah Swindley, CEO, Lancahire Women's Centres, VCFS Rep Gary Hall, Lancashire District Councils Jane Booth, Independent Chair, Lancashire Safeguarding Children's Board Dee Roach, Lancashire Care NHS Foundation Trust (on behalf of Heather Tierney-Moore) David Tilleray, Chair West Lancs HWB Partnership Dr John Caine, West Lancashire CCG Councillor Tony Harrison, East Lancs HWB Partnership Clare Platt, Health Equity, Welfare & Partnerships Cllr Viv Willder, Fylde Borough Council Jan Ledward, Chorley and South Ribble CCG Apologies County Councillor Tony Martin Cabinet Member for Adult and Community Services

(LCC) Dr Gora Bangi Chorley and South Ribble CCG Michael Wedgeworth Healthwatch Lancashire Interim Chair Graham Urwin NHS England, Lancashire and Greater Manchester Mark Bates Assistant Chief Constable, Lancashire Constabulary Mark Youlton East Lancashire CCG

1. Apologies

Apologies for absence were noted as above.

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The Board were informed of a number of new members as follows: • Councillor Viv Willder – Fylde Borough Council (replacing Councillor Cheryl Little) • Mark Youlton – East Lancashire CCG (replacing Dr Mike Ions) • Dr John Caine – West Lancashire CCG (replacing Dr Simon Frampton and Lucinda

McArthur) 2. Disclosure of Pecuniary and Non-Pecuniary Interests

Dr Tony Naughton declared a non-pecuniary interest as Chair of Fylde and Wyre Health and Wellbeing Board Partnership. 3. Minutes of the Last Meeting

Minutes from the meeting held on 22 February 2016 were agreed as a true and accurate record. 4. Better Care Fund 2016/17 Submission

Paul Robinson spoke to this item. The purpose of the report is to inform the Lancashire Health and Wellbeing Board on the progress of and rationale around the development of the Lancashire Better Care Fund (BCF) Plan for 2016/17 and to seek the Board’s approval of the plan. On page 2 of the report in the sentence: “The plan therefore includes all schemes of the 2015/16 plan, with some minor name changes, along with an additional scheme of Carer support in Fylde and Wyre". The reference to the additional scheme in Fylde and Wyre should be removed. The sentence reflected where the plan was at when the report was written. Fylde and Wyre CCG will be managing that activity outside of the BCF. The Lancashire BCF Plan for 2016/17 will build upon that for 2015/16 and take an approach that ensures stability and consolidation. The schemes within the plan will vary little in outward appearance from those seen in 15/16 but will be stronger in how they deliver. This is an approach agreed across all BCF partners. It reflects the changing planning environment, and a central government desire for BCF focus on addressing the issues around hospital admission avoidance and safe, timely discharge. It also enables partners to best manage resources at a time of continuing financial uncertainty and increased system pressures. The Lancashire BCF plan 2016/17 aligns with all CCGs (Clinical Commissioning Groups) and Lancashire County Council's operating plans being now part of “business as usual” planning. Further ambitions expressed for the BCF have not been lost but redirected into the Healthier Lancashire and Lancashire and South Cumbria Sustainability Transformation Plan work programmes. The BCF will continue to be a core part of the move to greater integration and as part of the work within the BCF plan in 2016/17 lay the ground for a plan for integration of Health and Social Care. The BCF plan 2016/17 sees significant strengthening of the input of the City and Borough Councils and Voluntary sector that will bring a whole new set of skills and resources into delivering its priorities and schemes. Built into the plan is the early refresh of delivery plans for schemes and this will reflect that wider view of who can contribute and the prospect of greater coordination/integration.

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The centrally prescribed format of the BCF plan for 2016/17 has been slimmed down to a high level narrative, which refers to supporting documents, and a spreadsheet template submission of management information and financial plan detail. The Board noted that Gary Hall was now a member of the BCF Steering Group. The financial arrangements for the Better Care Fund are based around a centrally defined level of minimum contributions that CCGs will make to the BCF pooled fund. In addition Lancashire County Council contributes against agreed schemes. Also added to the pooled fund is an amount for the provision of Disabled Facilities Grants which is then distributed to City and Borough Councils so that they can fulfil their statutory duties. This is £11,476,00 in 2016/17. The total BCF pooled fund for 2016/17 is £91,419,000. The detailed allocation of this is set out in the BCF plan. The agreement to pool these funds is set out in a Section 75 agreement between Lancashire County Council and all Lancashire CCGs. Lancashire County Council has agreed to host the pooled fund and manages the financial processes required. Resolved: that as the Lancashire Better Care Fund accountable body the Health and Wellbeing Board agreed to: • Endorse the approach taken in developing the Lancashire Better Care Fund plan 2016/17 • Approve the Lancashire Better Care Fund Plan 2016/17 and its submission to NHS England • A BCF quarterly reporting schedule to the board based upon that required by NHS England

and an evaluation of the BCF Plan for 2015/16 be brought to the next meeting on 13 June 2016

• Amend the new plan as and when necessary Further information on the BCF Fund Submission is attached as requested at the meeting. 5. Urgent Business

There were no items of urgent business. 6. Date of Next Meeting

The next scheduled meeting of the Board will be held at 10.00am on Monday, 13 June 2016 in the Duke of Lancaster Room (formerly Cabinet Room 'C'), County Hall, Preston, PR1 8RJ. I Young

Director of Governance, Finance and Public Services

County Hall Preston

S&O System Resilience Group (SRG) RATIFIED MINUTES

Date: Wednesday 18 May 2016, 0930 hrs to 1130 hrs Venue: Almond Room, Family Life Centre, Ash Street, Southport, PR8 6JH Attendees Fiona Taylor (CHAIR) Chief Officer, Southport & Formby CCG FLT John Betteridge Sector Manager – North, Cheshire & Merseyside Area, NWAS JB Dr Rob Caudwell Chair, Southport & Formby CCG RC Billie Dodd Head of CCG Development, Southport & Formby CCG BD Trevor Hubbard Assistant Director of Operations – Interim, Southport & Ormskirk Hospitals NHS Trust TH David Hughes Manager, Sefton New Directions (on behalf of Penny Fell) DH Stuart Jackson Deputy Director of Delivery, NHS England - Cheshire & Merseyside SJ Mike Maguire Chief Officer, West Lancashire CCG MM Debbie Mallett Service Development Manager, Cheshire & Merseyside, NWAS DM Mark Waterhouse Head Social Worker, Sefton Council MW In Attendance Kay Millington Regional Capacity Management Team, Midlands and Lancashire CSU KM Liz Melia Commissioning Lead, Quality Improvement, MLCSU LM Andrew Watkinson Information Team, Southport & Ormskirk Hospitals NHS Trust AW Apologies Jeanette Abraham Assistant Director of Operations Planned Care, Southport & Ormskirk Hospitals NHS Trust JA Kate Burgess Commissioning Manager, Lancashire County Council KB Dr John Caine Chair, West Lancashire CCG JC Tracey Cook-Scowen Deputy Clinical Director - Adult Community Services, Lancashire Care NHS Foundation Trust TC-S Debbie Curran General Manager, Community & Continued Care DC Simon Featherstone Director of Nursing & Quality, Southport & Ormskirk Hospitals NHS Trust SF Penelope Fell Chief Operating Officer, New Directions PF Christine Fisher Mersey Care NHS Trust CF Claire Heneghan Chief Nurse, West Lancashire CCG CH Lisa Hunt Interim Chief Operating Officer, Southport & Ormskirk Hospitals NHS Trust LH Charlotte McAllister Urgent Care Commissioning Lead, West Lancashire CCG CMcA Karl McCluskey Chief Strategy & Outcomes Officer CCG KMcC Clare Mattison Manager - Policy, Commissioning and Business Information – Age Well, Lancs CC CM Kieran Murphy Medical Director, NHS England Cheshire & Merseyside KM Joanna Stark Assoc Director of Operations - Women’s & Children’s Services and Community & Cont Care JS Michell Walling Directorate Manager, Community & Cont Care, Southport & Ormskirk Hospitals NHS Trust MWal Tina Wilkins Head of Service, Vulnerable People, Sefton Council TW

NO ITEM ACTION SRG16/36 Welcome, Introductions & Apologies

Apologies were received from Mark Sergeant, Michael Lightfoot, Karl McCluskey, Bapi Biswas, John Caine, Tracey Cookscowen, Penny Fell, Claire Heneghan, Lisa Hunt, Clare Mattison, Joanna Stark, Kate Burgess and Luke Garner

SRG16/37 Notes and Actions from Previous Meeting The notes were accepted as a true and accurate record. Actions SRG15/34f (SRG15/31b) Performance dashboard & capacity & demand. Remove from tracker. Kay to email today to chase up request name of representative SRF15/35b Performance dashboard & capacity & demand – care homes. BI work has caused some delay. DM to provide access to NWAS care home data. BD to liaise with Moira McGuinness, DM, CMcA, LG. SRG15/35c Performance dashboard and capacity and demand – Manchester House BD/TH to progress with DC. Analysis required by next meeting. Add to agenda SRG15/35d Performance dashboard & capacity & demand – over 75’s data Merge with SRG15/35b SRG15/44 Any other business – flu resilience. SJ to bring lessons learned to next SRG. Add to agenda SRG16/9 Paediatric 12-Hour breach RCA. Issue resolved and issue to be signed off. Remove from tracker next meeting

KM

SJ

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SRG16/25 NWAS Ambulance turnaround performance. Working with Terry Hill (TH). Feedback progress at next meeting. Add to agenda SRG16/26 Trajectory for recovery of A&E target. Looking to provide mental health room at S&O and additional requirements to support this. CMcA and TH to discuss Interfaces between mental health providers. SRG16/32 Easter plan – debrief. Feedback requested by email. Themes will be presented at next meeting. Add to agenda SRG16/34a Any other business – frequent attenders at Aintree. BD to chase – this is a mental health issue at Aintree SRG16/34b Any other business – reducing DTOCs. Reduced by 1%, remove from tracker.

JBy

CMcA/TH

JBy

SRG16/38 Update on EMS project Delays nominating the pilot project representatives has resulted in slippage of timescales. FLT reminded the group to send names to LM (for providing data – pressure level and bed capacity). Assurance was given that the EMS data quality team would respond to data submitted if pressure levels appeared inconsistent. Virtual group could be set up (via SOORN) to share experience, lessons learned from other areas.

SRG16/39 Performance dashboard and capacity and demand 1, 2 and 3 A&E Trajectory to hit 91% reached but not yet sustained. Some issues after bank holiday (GP referral numbers and lack of discharge during the weekend). SJ recommended developing 3 or 4 day generic plans to apply to each bank holiday (ease of deployment and revise using lessons learned). This replacement is already happening and preparations are already underway for the next bank holiday (extra discharge planner, social services, consultant support). Learning from daily huddles already being implemented and availability of Sefton New Directions to support discharges will be sought as well as involving social workers in daily huddles to increase their visibility. Myths and behaviours need to be understood and challenged (perceived poor availability of GP appointments, extended GP opening not taken up (Sunday), alternatives to A&E not known). Action: BD/TH to review referral flow from primary care; holiday leave planning (following bank holiday) for discussion at next meeting 3 Paediatrics Capacity at Alder Hey affecting Ormskirk. Attendances between 18:00 – 22:00 under pressure (staff cover). Primary care support may help Action: BD to ask Carol McAbrey, Rob Caudwell, Jack Kinsey and Peter Wong to discuss and bring back to SRG 10 DTOCS Action: AW to check DTOC reporting against NHSE definition (although figures currently taken from NHSE website) Other 62 day cancer wait figures should be included in reporting

TH

BD/TH

BD

AW

AW SRG16/40 AQuA and whole system flow

SOORN will look at programme of work around Urgent Emergency Care Network (ensuring no duplication with EMS). Yvonne Taylor, Wendy Lewis, John Betteridge to attend. Yvonne Taylor has already been involved so could advise the group. Action: BD to coordinate for next SOORN

BD

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SRG16/41 Workshop – planning BD asked for feedback into the System Resilience Group plans. Action: Group members to provide updates to plan The group discussed the eight high impact actions as they related to Acute care identifying what is currently being done, what could be done differently. The following progress and actions were noted from the group discussion: Progress: • started – ambulatory care unit in place from June • stopped – GPAU (now put through ACU) • started – GP hot clinic for GP referrals (come back next day). Include radiology? • started – GP hotline • start – open access diagnostics. Has radiology this been well communicated to

GPs • Aim to- free up consultants capacity in A&E • start more diagnostics in primary care (work in West Lancs has lessened the

impact on the Trust) • started – daily huddle – now hitting surgery discharge dates, identify patients for

discharge the night before. Use a count of patients not percentage for visibility and accountability

• started – weekend supported discharges (preparation for discharge) • started – extra consultants • started – each patient receives daily senior clinical review • continue – AEC principles not pathways • started – internal escalation plan reviewed for EDD (EDD kick-starts other

responses) • done differently - fortnightly capacity / escalation planning meetings (replacing

Winter / Easter planning) To Do: • repeat a review of timings/ staffing/ times of day of attendance and pressures • consider technology eg CONSULT package for GPAU • consider removing trolleys from GPAU (like Countess of Chester where patients

transfer to a chair wherever possible) to free space and increase patient visibility. • obtain and review feedback from primary care re open access radiology (do GPs

know what is available?) • consider “red card” for A&E attendees who could obtain GP appointment now, or

access alternative to A&E. Book the appointment for them. • Mike Maguire to circulate PCC presentation about timings and shift patterns around

support • Act upon and communicate any learning resulting from unusual incidences and

define process where patterns/ repeats emerge eg send patient direct to DVT clinic early in the day not via A&E (under used service in DVT clinic / delays in patient treatment)

• Use DoS, inform GPs, put in patient plan, communicate plans with patients to support and prevent revisits, share pathways

• Look at 6 or 7 pathways looking for blockages, problems across organisational boundaries.

• Fix the broken – eg GP referrals, anecdotal problems • Check how pathways are shared (eg across boundaries, with OOH) • Investigate discrepancies / variation in EDD estimates and actuals. Consider

estimating/ measuring differently. Other factors eg patient choice, DTOC etc • Consider opportunities to form cross Trust alliances (system wide escalation plan) • Consider impact of increase in elderly migrating to new care homes in Southport

and the impact of changing health and fortunes. • 3,4 day generic system wide escalation plan (repeatability, easy to change, same

approach each time)

All

MM

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SRG16/42 Any other business None noted

SRG16/43 Date of next meeting Wednesday 15th June 2016, 09:30 to 11:30 hrs, Family Life Centre, Ash Street, Southport, PR8 6JH